{
  "resourceType": "Questionnaire",
  "id": "MI-SplittingExample",
  "language": "en",
  "text": {
    "status": "extensions",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire MI-SplittingExample</b></p><a name=\"MI-SplittingExample\"> </a><a name=\"hcMI-SplittingExample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p></div><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" class=\"xhtTableBorder1\"><tr class=\"xhtRowBorder2\"><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Other attributes of the item\">Flags</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description &amp; Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1.png)\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> </td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Standardized medical imaging referral questionnaire used as a splitting/sectioning example for implementation and testing.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Questionnaire</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">http://ontariohealth.ca/fhir/eforms/Questionnaire/MI-SplittingExample#1.2.0</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck10.png)\" id=\"item.283714301370\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> 283714301370</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Please note that screening programs such the Ontario Breast Screening Program (OBSP) and Ontario Lung Screening Program (OLSP) have dedicated provincial intake forms and eligibility criteria. Please check program website for referral forms.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.patient_header\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> patient_header</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Patient Information</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_surname\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_surname</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Surname:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_firstname\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_firstname</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">First Name:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_date_of_birth\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_date_of_birth</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">DOB:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_gender\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_gender</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Gender:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.patient_gender\">3 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_hc_pc\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_hc_pc</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">HN PC:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Max Length: 2</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_hc_number\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_hc_number</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">HN:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Max Length: 10</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_hc_vc\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_hc_vc</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">HN VC:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_address_line1\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_address_line1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Address (Line 1):</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_address_line2\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_address_line2</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Address (Line 2):</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_address_city\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_address_city</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">City:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_address_province\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_address_province</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Province:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Max Length: 2</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_address_postalcode\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_address_postalcode</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Postal Code:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_phone_mobile\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_phone_mobile</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Mobile #:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_phone_home\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_phone_home</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Home #:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.patient_phone_business\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_phone_business</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Business #:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.patient_email\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">patient_header / </span>patient_email</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Email:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.additionalinfo_header\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> additionalinfo_header</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">[Optional] Additional Patient Information</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_sexassignedatbirth\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_sexassignedatbirth</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Sex assigned at birth:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_sexassignedatbirth\">4 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_pronouns\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_pronouns</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Pronouns:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_pronouns\">4 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_pronouns_other\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_pronouns_other</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Other pronouns:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_pronouns\">additionalinfo_pronouns</a> = Other</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredlanguage\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_preferredlanguage</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Preferred language:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_preferredlanguage\">3 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredlanguage_specify\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_preferredlanguage_specify</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Specify:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_preferredlanguage\">additionalinfo_preferredlanguage</a> = Other</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredlanguage_translatorrequired\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_preferredlanguage_translatorrequired</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Translator required</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_preferredlanguage\">additionalinfo_preferredlanguage</a> = Other</span><br/>Options: <a href=\"#opt-item.additionalinfo_preferredlanguage_translatorrequired\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredname_select\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_preferredname_select</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Preferred name</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_preferredname_select\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredname\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_preferredname</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Prefered name String</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_preferredname_select\">additionalinfo_preferredname_select</a> = Preferred Name</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_bestmethodofcontact\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_bestmethodofcontact</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Best method of contact:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_bestmethodofcontact\">4 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_bestmethodofcontact_voicemails\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_bestmethodofcontact_voicemails</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Voicemails acceptable</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_bestmethodofcontact_voicemails\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_select\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_alternatecontact_select</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Alternate contact</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_alternatecontact_select\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_name\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_alternatecontact_name</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Name:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_phone\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_alternatecontact_phone</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Alternate contact phone #:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_relationship\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_alternatecontact_relationship</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Relationship:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_bookingcontact\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_alternatecontact_bookingcontact</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Is Alternate contact the appointment booking contact?:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span><br/>Options: <a href=\"#opt-item.additionalinfo_alternatecontact_bookingcontact\">2 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_unsafecontacts_select\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_unsafecontacts_select</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Unsafe contact persons (do not speak with)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_unsafecontacts_select\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_unsafecontacts_speakwithpatientdirectly\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_unsafecontacts_speakwithpatientdirectly</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Only speak with patient directly</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_unsafecontacts_select\">additionalinfo_unsafecontacts_select</a> = Unsafe contact persons (do not speak with)</span><br/>Options: <a href=\"#opt-item.additionalinfo_unsafecontacts_speakwithpatientdirectly\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_unsafecontacts_donotspeakwith\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_unsafecontacts_donotspeakwith</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Do not speak with:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_unsafecontacts_select\">additionalinfo_unsafecontacts_select</a> = Unsafe contact persons (do not speak with)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_accessibilityconcernsordisability_selectt\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_accessibilityconcernsordisability_selectt</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Accessibility concerns or disability</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_accessibilityconcernsordisability_selectt\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_accessibilityconcernsordisability\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_accessibilityconcernsordisability</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Accessibility concerns Options</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_accessibilityconcernsordisability_selectt\">additionalinfo_accessibilityconcernsordisability_selectt</a> = Accessibility concerns or disability</span><br/>Options: <a href=\"#opt-item.additionalinfo_accessibilityconcernsordisability\">4 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_specialconsiderations_select\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_specialconsiderations_select</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.additionalinfo_specialconsiderations_select\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_specialconsiderations\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>additionalinfo_specialconsiderations</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Details of special considerations:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.additionalinfo_specialconsiderations_select\">additionalinfo_specialconsiderations_select</a> = Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.780152781664\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>780152781664</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Payer Type</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.780152781664\">6 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.273459321091\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">additionalinfo_header / </span>273459321091</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Other</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.780152781664\">780152781664</a> = Other</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.274716928898\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 274716928898</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Select Exam Request(s)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.966479448516\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">274716928898 / </span>966479448516</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Radiology modality selection</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.966479448516\">5 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.324277291256\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 324277291256</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Triage Considerations Information appear on summary note for ALL child referrals</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <ul><li><a href=\"#item.966479448516\">966479448516</a> = Computerized axial tomography (SNOMED CT#77477000)</li><li><a href=\"#item.966479448516\">966479448516</a> = Magnetic resonance imaging (SNOMED CT#113091000)</li><li><a href=\"#item.966479448516\">966479448516</a> = Radiographic imaging procedure (SNOMED CT#363680008)</li><li><a href=\"#item.966479448516\">966479448516</a> = Ultrasound scan (SNOMED CT#16310003)</li><li><a href=\"#item.966479448516\">966479448516</a> = Dual energy X-ray absorptiometry (procedure) (SNOMED CT#241686001)</li></ul></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.649843000897\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">324277291256 / </span>649843000897</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Requested Priority:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.649843000897\">2 options</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.871328372177\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">324277291256 / </span>871328372177</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Reason for urgent triage</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.649843000897\">649843000897</a> = Urgent (RequestPriority#urgent)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.751330438729\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 751330438729</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">CT Request: Clinical History / Indication - Information appear on summary note for CT child referrals</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.966479448516\">966479448516</a> = Computerized axial tomography (SNOMED CT#77477000)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.573180718837\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">751330438729 / </span>573180718837</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Reason for exam (please also include presenting symptom(s), relevant underlying diagnosis and therapies, where applicable)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.234264354051\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 234264354051</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">MRI Request: Clinical History / Indication - Information appear on summary note for MRI child referrals</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.966479448516\">966479448516</a> = Magnetic resonance imaging (SNOMED CT#113091000)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.980027687215\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">234264354051 / </span>980027687215</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Reason for exam (please also include presenting symptom(s), relevant underlying diagnosis and therapies, where applicable)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.674405234837\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 674405234837</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">X-Ray Request: Clinical History / Indication - Information appear on summary note for XRAY child referrals</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.966479448516\">966479448516</a> = Radiographic imaging procedure (SNOMED CT#363680008)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.510703120136\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">674405234837 / </span>510703120136</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Reason for exam (please also include presenting symptom(s), relevant underlying diagnosis and therapies, where applicable)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.536888455666\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 536888455666</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Ultrasound Request: Clinical History / Indication - Information appear on summary note for Ultrasound child referrals</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.966479448516\">966479448516</a> = Ultrasound scan (SNOMED CT#16310003)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.296349058128\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">536888455666 / </span>296349058128</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Reason for exam (please also include presenting symptom(s), relevant underlying diagnosis and therapies, where applicable)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.189996950901\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 189996950901</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">BMD Request: Clinical History / Indication - Information appear on summary note for BMD child referrals</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.966479448516\">966479448516</a> = Dual energy X-ray absorptiometry (procedure) (SNOMED CT#241686001)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.799876967585\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">189996950901 / </span>799876967585</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Reason for exam (please also include presenting symptom(s), relevant underlying diagnosis and therapies, where applicable)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.351905130587\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 351905130587</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Supporting Documentation</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.707642937857\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">351905130587 / </span>707642937857</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Previous Relevant Imaging (if applicable)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.cpp_header\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> cpp_header</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.cpp_separate\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">cpp_header / </span>cpp_separate</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">CPP attached separately (if not entered below)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.cpp_separate\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.cpp_currentprob\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">cpp_header / </span>cpp_currentprob</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Current Problem List:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> != CPP attached separately (if not entered below)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.cpp_pastmedicalhistory\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">cpp_header / </span>cpp_pastmedicalhistory</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Past Medical History:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> != CPP attached separately (if not entered below)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.cpp_currentmedications\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">cpp_header / </span>cpp_currentmedications</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Current Medications:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> != CPP attached separately (if not entered below)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.cpp_familyhistory\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">cpp_header / </span>cpp_familyhistory</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Family History:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> != CPP attached separately (if not entered below)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.cpp_allergies\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">cpp_header / </span>cpp_allergies</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Allergies:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> != CPP attached separately (if not entered below)</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.preferredconsultlocation_header\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> preferredconsultlocation_header</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.preferredconsultlocation_selector\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">preferredconsultlocation_header / </span>preferredconsultlocation_selector</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Preferred consultant or location</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.preferredconsultlocation_selector\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck111.png)\" id=\"item.preferredconsultlocation_specify\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">preferredconsultlocation_header / </span>preferredconsultlocation_specify</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Please specify either a preferred consultant or location</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.preferredconsultlocation_selector\">preferredconsultlocation_selector</a> = Preferred consultant or location</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck1110.png)\" id=\"item.preferredconsultlocation_consultant\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">preferredconsultlocation_header / preferredconsultlocation_specify / </span>preferredconsultlocation_consultant</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Consultant:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1100.png)\" id=\"item.preferredconsultlocation_location\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">preferredconsultlocation_header / preferredconsultlocation_specify / </span>preferredconsultlocation_location</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Location:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.preferredconsultlocation_willingtotravel\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">preferredconsultlocation_header / </span>preferredconsultlocation_willingtotravel</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Patient willing to travel for shorter wait time</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.preferredconsultlocation_willingtotravel\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.preferredconsultlocation_otherconsiderations\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">preferredconsultlocation_header / </span>preferredconsultlocation_otherconsiderations</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Other considerations:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.supportingdocumentation_header\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> supportingdocumentation_header</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.supportingdocumentation_details\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">supportingdocumentation_header / </span>supportingdocumentation_details</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Personal Health Information that is medically relevant has not been disclosed at the request of the patient.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"\"/></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.supportingdocumentation_details\">1 option</a></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck10.png)\" id=\"item.supportingdocumentation_attachment\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-attachment.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"attachment\" class=\"hierarchy\"/> supportingdocumentation_attachment</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Add Attachments</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-attachment\">attachment</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck10.png)\" id=\"item.feedbacksurvey_universal\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> feedbacksurvey_universal</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Click here to provide feedback on this form</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck01.png)\" id=\"item.referrer_header\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> referrer_header</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Referrer's Information</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_sitename\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_sitename</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Site Name:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_address_line1\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_address_line1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Address (Line 1):</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_address_line2\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_address_line2</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Address (Line 2):</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_address_city\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_address_city</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">City:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_address_province\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_address_province</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Province:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Max Length: 2</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_address_postalcode\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_address_postalcode</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Postal Code:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_phone\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_phone</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Phone #:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_fax\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_fax</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Fax #:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_billing\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-integer.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"integer\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_billing</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Billing Number:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer\">integer</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_professionalid\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-integer.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"integer\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_professionalid</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Professional ID:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer\">integer</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.referrer_signature\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_signature</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Signed:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck000.png)\" id=\"item.referrer_role\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">referrer_header / </span>referrer_role</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Role:</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Options: <a href=\"#opt-item.referrer_role\">9 options</a></td></tr>\r\n<tr><td colspan=\"6\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name=\"opt-item.patient_gender\"> </a><p><b>Answer options for patient_gender </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#male (&quot;Male&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#female (&quot;Female&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#other (&quot;Other&quot;)</li></ul><a name=\"opt-item.additionalinfo_sexassignedatbirth\"> </a><p><b>Answer options for additionalinfo_sexassignedatbirth </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA3-6 (&quot;Female&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA2-8 (&quot;Male&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Intersex&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA4489-6 (&quot;Unknown&quot;)</li></ul><a name=\"opt-item.additionalinfo_pronouns\"> </a><p><b>Answer options for additionalinfo_pronouns </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA29519-8 (&quot;she/her/her/hers/herself&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA29518-0 (&quot;he/him/his/his/himself&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA29520-6 (&quot;they/them/their/theirs/themselves&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.additionalinfo_preferredlanguage\"> </a><p><b>Answer options for additionalinfo_preferredlanguage </b></p><ul><li style=\"font-size: 11px\">urn:ietf:bcp:47#en (&quot;English&quot;)</li><li style=\"font-size: 11px\">urn:ietf:bcp:47#fr (&quot;French&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.additionalinfo_preferredlanguage_translatorrequired\"> </a><p><b>Answer options for additionalinfo_preferredlanguage_translatorrequired </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Translator Required&quot;)</li></ul><a name=\"opt-item.additionalinfo_preferredname_select\"> </a><p><b>Answer options for additionalinfo_preferredname_select </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Preferred Name&quot;)</li></ul><a name=\"opt-item.additionalinfo_bestmethodofcontact\"> </a><p><b>Answer options for additionalinfo_bestmethodofcontact </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#mobile (&quot;Mobile&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#home (&quot;Home&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#work (&quot;Work&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-system#email (&quot;Email&quot;)</li></ul><a name=\"opt-item.additionalinfo_bestmethodofcontact_voicemails\"> </a><p><b>Answer options for additionalinfo_bestmethodofcontact_voicemails </b></p><ul><li style=\"font-size: 11px\">null#null (&quot; Voicemails acceptable&quot;)</li></ul><a name=\"opt-item.additionalinfo_alternatecontact_select\"> </a><p><b>Answer options for additionalinfo_alternatecontact_select </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Alternate contact&quot;)</li></ul><a name=\"opt-item.additionalinfo_alternatecontact_bookingcontact\"> </a><p><b>Answer options for additionalinfo_alternatecontact_bookingcontact </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li></ul><a name=\"opt-item.additionalinfo_unsafecontacts_select\"> </a><p><b>Answer options for additionalinfo_unsafecontacts_select </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Unsafe contact persons (do not speak with)&quot;)</li></ul><a name=\"opt-item.additionalinfo_unsafecontacts_speakwithpatientdirectly\"> </a><p><b>Answer options for additionalinfo_unsafecontacts_speakwithpatientdirectly </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Only speak with patient directly&quot;)</li></ul><a name=\"opt-item.additionalinfo_accessibilityconcernsordisability_selectt\"> </a><p><b>Answer options for additionalinfo_accessibilityconcernsordisability_selectt </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Accessibility concerns or disability&quot;)</li></ul><a name=\"opt-item.additionalinfo_accessibilityconcernsordisability\"> </a><p><b>Answer options for additionalinfo_accessibilityconcernsordisability </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#129839007 (&quot;At risk for falls&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#301621006 (&quot;Uses lift&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#105503008 (&quot;Dependence on wheelchair&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#15188001 (&quot;Hearing impaired&quot;)</li></ul><a name=\"opt-item.additionalinfo_specialconsiderations_select\"> </a><p><b>Answer options for additionalinfo_specialconsiderations_select </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)&quot;)</li></ul><a name=\"opt-item.780152781664\"> </a><p><b>Answer options for 780152781664 </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;OHIP&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;WSIB Case&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;DND&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;IFH&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;RAMQ&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.966479448516\"> </a><p><b>Answer options for 966479448516 </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#77477000 (&quot;Computerized axial tomography&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#113091000 (&quot;Magnetic resonance imaging&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#363680008 (&quot;Radiographic imaging procedure&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#16310003 (&quot;Ultrasound scan&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#241686001 (&quot;Dual energy X-ray absorptiometry (procedure)&quot;)</li></ul><a name=\"opt-item.649843000897\"> </a><p><b>Answer options for 649843000897 </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/request-priority#routine (&quot;Routine&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/request-priority#urgent (&quot;Urgent&quot;)</li></ul><a name=\"opt-item.cpp_separate\"> </a><p><b>Answer options for cpp_separate </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;CPP attached separately (if not entered below)&quot;)</li></ul><a name=\"opt-item.preferredconsultlocation_selector\"> </a><p><b>Answer options for preferredconsultlocation_selector </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Preferred consultant or location&quot;)</li></ul><a name=\"opt-item.preferredconsultlocation_willingtotravel\"> </a><p><b>Answer options for preferredconsultlocation_willingtotravel </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Patient willing to travel for shorter wait time&quot;)</li></ul><a name=\"opt-item.supportingdocumentation_details\"> </a><p><b>Answer options for supportingdocumentation_details </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Personal Health Information that is medically relevant has not been disclosed at the request of the patient.&quot;)</li></ul><a name=\"opt-item.referrer_role\"> </a><p><b>Answer options for referrer_role </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#309398001 (&quot;Profession allied to medicine&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#62247001 (&quot;Family doctor&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#449161006 (&quot;Physician assistant&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#398130009 (&quot;Medical student&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#106292003 (&quot;Nurse&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#224571005 (&quot;Nurse practitioner&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#405277009 (&quot;Resident physician&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#69280009 (&quot;Specialized physician&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><h2>Contained Resources</h2><hr/>\n  <table class=\"narrative-table\">\n    <tbody>\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"metadata\"> </a>Metadata</th>\n\n\n</tr>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Experimental</th>\n\n\n\n<td class=\"content-container\">true</td>\n\n\n</tr>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Description</th>\n\n\n\n<td class=\"content-container\">HTML with embedded [FHIRPath Liquid](https://confluence.hl7.org/spaces/FHIR/pages/66938964/FHIR+Liquid+Profile) that is intended to be executed against QuestionnaireResponses based on this Questionnaire.</td>\n\n\n</tr>\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n\n<td class=\"content-container\">\n    <a href=\"CodeSystem-library-types.html\">http://ontariohealth.ca/fhir/eforms/CodeSystem/library-types</a>#qr-narrative-liquid\n\n\n</td>\n\n\n</tr>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"parameters\"> </a>Parameters</th>\n\n\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Parameter</th>\n\n\n\n<td class=\"content-container\">None</td>\n\n\n</tr>\n\n\n\n\n\n\n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Library Content</th>\n\n\n</tr>\n  \n    \n    <tr>\n      <th scope=\"row\" class=\"row-header\">text/htmlContent</th>\n      <td>\n        <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code>Encoded data </code></pre>\n      </td>\n    </tr>\n    \n  \n\n\n\n<tr>\n  <th colspan=\"2\" scope=\"row\" class=\"row-header\">Generated using version 0.5.6 of the sample-content-ig Liquid templates</th>\n</tr>\n\n    </tbody>\n  </table>\n</div>"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "liquid",
      "status": "active",
      "experimental": true,
      "type": {
        "coding": [
          {
            "system": "http://ontariohealth.ca/fhir/eforms/CodeSystem/library-types",
            "code": "qr-narrative-liquid"
          }
        ]
      },
      "description": "HTML with embedded [FHIRPath Liquid](https://confluence.hl7.org/spaces/FHIR/pages/66938964/FHIR+Liquid+Profile) that is intended to be executed against QuestionnaireResponses based on this Questionnaire.",
      "content": [
        {
          "contentType": "text/html",
          "data": "<div>{% capture childItems %}{% if QuestionnaireResponse.item.where(linkId = 'patient_header').exists() %}<span style="font-weight:bold;text-decoration:underline;">Patient Information</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = 'patient_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'patient_surname' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_surname' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Surname</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_firstname' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_firstname' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">First Name</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_date_of_birth' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_date_of_birth' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">DOB</span> {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_gender' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_gender' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Gender</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_hc_pc' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_hc_pc' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">HN PC</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_hc_number' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_hc_number' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">HN</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_hc_vc' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_hc_vc' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">HN VC</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_line1' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_line1' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Address</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_line2' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_line2' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Address Line 2</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_city' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_city' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">City</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_province' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_province' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Province</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_postalcode' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_postalcode' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Postal Code</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_phone_mobile' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_phone_mobile' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Mobile #</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_phone_home' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_phone_home' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Home #</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_phone_business' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_phone_business' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Business #</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_email' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_email' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Email</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'additionalinfo_header').exists() %}<span style="font-weight:bold;text-decoration:underline;">[Optional] Additional Patient Information</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = 'additionalinfo_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'additionalinfo_sexassignedatbirth' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_sexassignedatbirth' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Sex assigned at birth</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_pronouns' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_pronouns' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Pronouns</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_pronouns_other' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_pronouns_other' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Other Pronouns</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Preferred language</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_specify' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_specify' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Specify</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_translatorrequired' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_translatorrequired' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Translator required</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredname_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredname_select' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Preferred name</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredname' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredname' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Preferred Name:</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Best method of contact</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact_voicemails' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact_voicemails' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Voicemails acceptable</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_alternatecontact_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_alternatecontact_select' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Alternate contact</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_alternatecontact_name' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_alternatecontact_name' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Name</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_alternatecontact_phone' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_alternatecontact_phone' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Alternate contact phone #</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_alternatecontact_relationship' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_alternatecontact_relationship' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Relationship</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_alternatecontact_bookingcontact' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_alternatecontact_bookingcontact' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Is Alternate contact the appointment booking contact?</span> {% for answer in currentItem.answer %}{% if answer.value.display = 'Yes' %}Yes{% endif %}{% if answer.value.display = 'No' %}No{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_select' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Unsafe contact persons (do not speak with)</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_speakwithpatientdirectly' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_speakwithpatientdirectly' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Only speak with patient directly</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_donotspeakwith' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_donotspeakwith' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Do not speak with:</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_selectt' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_selectt' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Accessibility concerns or disability</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Specific</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_specialconsiderations_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_specialconsiderations_select' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Special considerations</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_specialconsiderations' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_specialconsiderations' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Details of special considerations</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = '780152781664' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '780152781664' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Payer Type</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = '273459321091' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '273459321091' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Other payer</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '274716928898').exists() %}<span style="font-weight:bold;text-decoration:underline;">Select Exam Request(s)</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '274716928898') %}{% capture childItems %}{% if currentItem.item.where(linkId = '966479448516' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '966479448516' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="display:none;">Radiology modality selection</span> {% 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 %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '324277291256').exists() %}<span style="font-weight:bold;">Triage Considerations</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '324277291256') %}{% capture childItems %}{% if currentItem.item.where(linkId = '649843000897' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '649843000897' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Requested Priority</span> {% for answer in currentItem.answer %}{% if answer.value.code = 'routine' %}Routine{% endif %}{% if answer.value.code = 'urgent' %}Urgent{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = '871328372177' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '871328372177' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for urgent triage</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '751330438729').exists() %}<span style="font-weight:bold;text-decoration:underline;">CT Request: Clinical History / Indication</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '751330438729') %}{% capture childItems %}{% if currentItem.item.where(linkId = '573180718837' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '573180718837' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for exam:</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '234264354051').exists() %}<span style="font-weight:bold;text-decoration:underline;">MRI Request: Clinical History / Indication</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '234264354051') %}{% capture childItems %}{% if currentItem.item.where(linkId = '980027687215' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '980027687215' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for exam:</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '674405234837').exists() %}<span style="font-weight:bold;text-decoration:underline;">X-Ray Request: Clinical History / Indication</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '674405234837') %}{% capture childItems %}{% if currentItem.item.where(linkId = '510703120136' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '510703120136' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for exam:</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '536888455666').exists() %}<span style="font-weight:bold;text-decoration:underline;">Ultrasound Request: Clinical History / Indication</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '536888455666') %}{% capture childItems %}{% if currentItem.item.where(linkId = '296349058128' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '296349058128' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for exam:</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '189996950901').exists() %}<span style="font-weight:bold;text-decoration:underline;">BMD Request: Clinical History / Indication</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '189996950901') %}{% capture childItems %}{% if currentItem.item.where(linkId = '799876967585' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '799876967585' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for exam:</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = '351905130587').exists() %}<span style="font-weight:bold;text-decoration:underline;">Supporting Documentation</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = '351905130587') %}{% capture childItems %}{% if currentItem.item.where(linkId = '707642937857' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = '707642937857' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Reason for exam:</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'cpp_header').exists() %}<span style="font-weight:bold;text-decoration:underline;">Cumulative Patient Profile</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = 'cpp_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'cpp_separate' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'cpp_separate' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">CPP attached separately</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'cpp_currentprob' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'cpp_currentprob' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Current Problem List</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'cpp_pastmedicalhistory' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'cpp_pastmedicalhistory' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Past Medical History</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'cpp_currentmedications' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'cpp_currentmedications' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Current Medication</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'cpp_familyhistory' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'cpp_familyhistory' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Family History</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'cpp_allergies' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'cpp_allergies' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Allergies</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'preferredconsultlocation_header').exists() %}<span style="font-weight:bold;text-decoration:underline;">Preferred Consultant or Location</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = 'preferredconsultlocation_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'preferredconsultlocation_selector' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'preferredconsultlocation_selector' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Preferred consultant or location</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'preferredconsultlocation_specify').exists() %}Please specify either a <b>preferred</b> consultant or location<br/> {% for currentItem in currentItem.item.where(linkId = 'preferredconsultlocation_specify') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'preferredconsultlocation_consultant' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'preferredconsultlocation_consultant' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Consultant</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'preferredconsultlocation_location' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'preferredconsultlocation_location' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Location</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'preferredconsultlocation_willingtotravel' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'preferredconsultlocation_willingtotravel' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Patient willing to travel for shorter wait time</span> {% 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 %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'preferredconsultlocation_otherconsiderations' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'preferredconsultlocation_otherconsiderations' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Other</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'supportingdocumentation_header').exists() %}<span style="font-weight:bold;"><b>Supporting Documentation</b><br/>Please attach all <b><span style="text-decoration: underline">relevant</span></b> laboratory and diagnostic investigations.<br/></span> {% for currentItem in QuestionnaireResponse.item.where(linkId = 'supportingdocumentation_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'supportingdocumentation_details' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'supportingdocumentation_details' and answer.exists()) %}{% if currentItem.answer.exists() %}{% 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 %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'supportingdocumentation_attachment' and answer.exists()).exists() %}{% for currentItem in QuestionnaireResponse.item.where(linkId = 'supportingdocumentation_attachment' and answer.exists()) %}{% if currentItem.answer.exists() %}Add Attachments {% endif %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'referrer_header').exists() %}<span style="font-weight:bold;text-decoration:underline;">Referrer's Information</span> {% for currentItem in QuestionnaireResponse.item.where(linkId = 'referrer_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'referrer_sitename' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_sitename' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Site Name</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_address_line1' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_address_line1' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Address (Line 1)</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_address_line2' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_address_line2' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Address (Line 2)</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_address_city' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_address_city' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">City</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_address_province' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_address_province' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Province</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_address_postalcode' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_address_postalcode' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Postal Code</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_phone' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_phone' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Phone #</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_fax' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_fax' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Fax #</span> {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_billing' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_billing' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Billing Number</span> {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_professionalid' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_professionalid' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Professional ID</span> {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_signature' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_signature' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Signed</span> {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'referrer_role' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'referrer_role' and answer.exists()) %}{% if currentItem.answer.exists() %}<span style="font-weight:bold;">Role</span> {% 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 %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}<br/>{% else %}<br/>{% endif %}{% endif %}{% endfor %}</div>"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
      "valueCoding": {
        "system": "http://hl7.org/fhir/version-algorithm",
        "code": "semver"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
      "valueCode": "random"
    },
    {
      "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/sdc-responseRenderingLiquid",
      "valueReference": {
        "reference": "#liquid"
      }
    }
  ],
  "url": "http://ontariohealth.ca/fhir/eforms/Questionnaire/MI-SplittingExample",
  "version": "1.2.0",
  "title": "Medical Imaging - Standardized Provincial Form Template - Splitting Example",
  "_title": {
    "extension": [
      {
        "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/core-short-string",
        "valueString": "test short string"
      }
    ]
  },
  "status": "active",
  "experimental": true,
  "subjectType": [
    "Patient"
  ],
  "publisher": "Ontario Health",
  "description": "Standardized medical imaging referral questionnaire used as a splitting/sectioning example for implementation and testing.",
  "_description": {
    "extension": [
      {
        "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/core-short-string",
        "valueString": "test description"
      }
    ]
  },
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "CA"
        }
      ]
    }
  ],
  "effectivePeriod": {
    "start": "2025-07-29"
  },
  "item": [
    {
      "linkId": "283714301370",
      "text": "Please note that screening programs such the Ontario Breast Screening Program (OBSP) and Ontario Lung Screening Program (OLSP) have dedicated provincial intake forms and eligibility criteria. Please check program website for referral forms.",
      "_text": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "Please note that screening programs such the <a href=\"https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-breast-obsp\">Ontario Breast Screening Program (OBSP)</a> and <a href=\"https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-lung-screening-program\">Ontario Lung Screening Program (OLSP)</a> have dedicated provincial intake forms and eligibility criteria. Please check program website for referral forms."
          }
        ]
      },
      "type": "display"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "code": "list",
                "display": "List"
              }
            ]
          }
        },
        {
          "extension": [
            {
              "url": "sortIndex",
              "valuePositiveInt": 1
            },
            {
              "url": "text",
              "valueString": "Patient Information"
            },
            {
              "url": "listSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "lastSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "style",
              "valueString": "font-weight:bold;text-decoration:underline;"
            },
            {
              "url": "groupItems",
              "valueBoolean": false
            }
          ],
          "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"
        }
      ],
      "linkId": "patient_header",
      "text": "Patient Information",
      "_text": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString": "font-weight:bold;"
          }
        ]
      },
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Surname"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_surname",
          "text": "Surname:",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "First Name"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_firstname",
          "text": "First Name:",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
              "valueString": "yyyy/MM/dd"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "DOB"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_date_of_birth",
          "text": "DOB:",
          "type": "date",
          "required": true
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button",
                    "display": "Radio Button"
                  }
                ]
              }
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Gender"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_gender",
          "text": "Gender:",
          "type": "choice",
          "required": true,
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "male",
                "display": "Male"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "female",
                "display": "Female"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "other",
                "display": "Other"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "HN PC"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_hc_pc",
          "text": "HN PC:",
          "type": "string",
          "maxLength": 2
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "HN"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_hc_number",
          "text": "HN:",
          "type": "string",
          "maxLength": 10
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/minLength",
              "valueInteger": 10
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "HN VC"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_hc_vc",
          "text": "HN VC:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Address"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_address_line1",
          "text": "Address (Line 1):",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Address Line 2"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_address_line2",
          "text": "Address (Line 2):",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "City"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_address_city",
          "text": "City:",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Province"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_address_province",
          "text": "Province:",
          "type": "string",
          "required": true,
          "maxLength": 2
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "postalcode1"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='patient_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid Canadian postal code in the format A1A 1A1."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Postal Code"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_address_postalcode",
          "text": "Postal Code:",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "phone1"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Mobile #"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_phone_mobile",
          "text": "Mobile #:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "phone2"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Home #"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_phone_home",
          "text": "Home #:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "phone3"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Business #"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_phone_business",
          "text": "Business #:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "email1"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='patient_email').answer.all(value.matches('(?:[a-z0-9!#$%&'*+/=?^_`{|}~-]+(?:\\.[a-z0-9!#$%&'*+/=?^_`{|}~-]+)*|\\\"(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21\\x23-\\x5b\\x5d-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])*\\\")@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\\\\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\\\\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21-\\x5a\\x53-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])+)\\])'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid email address."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Email"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "patient_email",
          "text": "Email:",
          "type": "string"
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "code": "list",
                "display": "List"
              }
            ]
          }
        },
        {
          "extension": [
            {
              "url": "sortIndex",
              "valuePositiveInt": 2
            },
            {
              "url": "text",
              "valueString": "[Optional] Additional Patient Information"
            },
            {
              "url": "listSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "lastSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "style",
              "valueString": "font-weight:bold;text-decoration:underline;"
            },
            {
              "url": "groupItems",
              "valueBoolean": false
            }
          ],
          "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"
        }
      ],
      "linkId": "additionalinfo_header",
      "text": "[Optional] Additional Patient Information",
      "_text": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString": "font-weight:bold;"
          }
        ]
      },
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button",
                    "display": "Radio Button"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Sex assigned at birth"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_sexassignedatbirth",
          "text": "Sex assigned at birth:",
          "type": "choice",
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA3-6",
                "display": "Female"
              }
            },
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA2-8",
                "display": "Male"
              }
            },
            {
              "valueCoding": {
                "display": "Intersex"
              }
            },
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA4489-6",
                "display": "Unknown"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button",
                    "display": "Radio Button"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Pronouns"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_pronouns",
          "text": "Pronouns:",
          "type": "choice",
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA29519-8",
                "display": "she/her/her/hers/herself"
              }
            },
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA29518-0",
                "display": "he/him/his/his/himself"
              }
            },
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA29520-6",
                "display": "they/them/their/theirs/themselves"
              }
            },
            {
              "valueCoding": {
                "display": "Other"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Other Pronouns"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_pronouns_other",
          "text": "Other pronouns:",
          "type": "string",
          "enableWhen": [
            {
              "question": "additionalinfo_pronouns",
              "operator": "=",
              "answerCoding": {
                "display": "Other"
              }
            }
          ],
          "enableBehavior": "all",
          "required": true
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button",
                    "display": "Radio Button"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Preferred language"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_preferredlanguage",
          "text": "Preferred language:",
          "type": "choice",
          "required": false,
          "answerOption": [
            {
              "valueCoding": {
                "system": "urn:ietf:bcp:47",
                "code": "en",
                "display": "English"
              }
            },
            {
              "valueCoding": {
                "system": "urn:ietf:bcp:47",
                "code": "fr",
                "display": "French"
              }
            },
            {
              "valueCoding": {
                "display": "Other"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Specify"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_preferredlanguage_specify",
          "text": "Specify:",
          "type": "string",
          "enableWhen": [
            {
              "question": "additionalinfo_preferredlanguage",
              "operator": "=",
              "answerCoding": {
                "display": "Other"
              }
            }
          ],
          "enableBehavior": "all",
          "required": true
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Translator required"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_preferredlanguage_translatorrequired",
          "text": "Translator required",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "enableWhen": [
            {
              "question": "additionalinfo_preferredlanguage",
              "operator": "=",
              "answerCoding": {
                "display": "Other"
              }
            }
          ],
          "repeats": true,
          "answerOption": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": "Translator Required"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Preferred name"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_preferredname_select",
          "text": "Preferred name",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": "Preferred Name"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Preferred Name:"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_preferredname",
          "text": "Prefered name String",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "string",
          "enableWhen": [
            {
              "question": "additionalinfo_preferredname_select",
              "operator": "=",
              "answerCoding": {
                "display": "Preferred Name"
              }
            }
          ],
          "enableBehavior": "all"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button",
                    "display": "Radio Button"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Best method of contact"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_bestmethodofcontact",
          "text": "Best method of contact:",
          "type": "choice",
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/contact-point-use",
                "code": "mobile",
                "display": "Mobile"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/contact-point-use",
                "code": "home",
                "display": "Home"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/contact-point-use",
                "code": "work",
                "display": "Work"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/contact-point-system",
                "code": "email",
                "display": "Email"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Voicemails acceptable"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            },
            {
              "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
              "valueExpression": {
                "language": "text/fhirpath",
                "expression": "%resource.repeat(item).where(linkId = 'additionalinfo_bestmethodofcontact').answer.value.where(display.lower() = 'home' or display.lower() = 'mobile' or display.lower() = 'business').exists()"
              }
            }
          ],
          "linkId": "additionalinfo_bestmethodofcontact_voicemails",
          "text": "Voicemails acceptable",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "enableBehavior": "any",
          "repeats": true,
          "answerOption": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": " Voicemails acceptable"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Alternate contact"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_alternatecontact_select",
          "text": "Alternate contact",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": "Alternate contact"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Name"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_alternatecontact_name",
          "text": "Name:",
          "type": "string",
          "enableWhen": [
            {
              "question": "additionalinfo_alternatecontact_select",
              "operator": "=",
              "answerCoding": {
                "display": "Alternate contact"
              }
            }
          ],
          "enableBehavior": "all",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "phone4"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Alternate contact phone #"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_alternatecontact_phone",
          "text": "Alternate contact phone #:",
          "type": "string",
          "enableWhen": [
            {
              "question": "additionalinfo_alternatecontact_select",
              "operator": "=",
              "answerCoding": {
                "display": "Alternate contact"
              }
            }
          ],
          "enableBehavior": "all"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Relationship"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_alternatecontact_relationship",
          "text": "Relationship:",
          "type": "string",
          "enableWhen": [
            {
              "question": "additionalinfo_alternatecontact_select",
              "operator": "=",
              "answerCoding": {
                "display": "Alternate contact"
              }
            }
          ],
          "enableBehavior": "all"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button",
                    "display": "Radio Button"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Is Alternate contact the appointment booking contact?"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_alternatecontact_bookingcontact",
          "text": "Is Alternate contact the appointment booking contact?:",
          "type": "choice",
          "enableWhen": [
            {
              "question": "additionalinfo_alternatecontact_select",
              "operator": "=",
              "answerCoding": {
                "display": "Alternate contact"
              }
            }
          ],
          "enableBehavior": "all",
          "answerOption": [
            {
              "valueCoding": {
                "display": "Yes"
              }
            },
            {
              "valueCoding": {
                "display": "No"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Unsafe contact persons (do not speak with)"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "additionalinfo_unsafecontacts_select",
          "text": "Unsafe contact persons (do not speak with)",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": "Unsafe contact persons (do not speak with)"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Only speak with patient directly"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
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                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": "Preferred consultant or location"
              }
            }
          ]
        },
        {
          "linkId": "preferredconsultlocation_specify",
          "text": "Please specify either a preferred consultant or location",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "Please specify either a <b>preferred</b> consultant or location"
              }
            ]
          },
          "type": "group",
          "enableWhen": [
            {
              "question": "preferredconsultlocation_selector",
              "operator": "=",
              "answerCoding": {
                "display": "Preferred consultant or location"
              }
            }
          ],
          "item": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Consultant"
                    },
                    {
                      "url": "sameLine",
                      "valueBoolean": false
                    },
                    {
                      "url": "quoteAnswer",
                      "valueBoolean": false
                    },
                    {
                      "url": "style",
                      "valueString": "font-weight:bold;"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
                }
              ],
              "linkId": "preferredconsultlocation_consultant",
              "text": "Consultant:",
              "type": "string"
            },
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Location"
                    },
                    {
                      "url": "sameLine",
                      "valueBoolean": false
                    },
                    {
                      "url": "quoteAnswer",
                      "valueBoolean": false
                    },
                    {
                      "url": "style",
                      "valueString": "font-weight:bold;"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
                }
              ],
              "linkId": "preferredconsultlocation_location",
              "text": "Location:",
              "type": "string"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Patient willing to travel for shorter wait time"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "preferredconsultlocation_willingtotravel",
          "text": "Patient willing to travel for shorter wait time",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "extension": [
                {
                  "extension": [
                    {
                      "url": "text",
                      "valueString": "Yes"
                    }
                  ],
                  "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"
                }
              ],
              "valueCoding": {
                "display": "Patient willing to travel for shorter wait time"
              }
            }
          ]
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Other"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "preferredconsultlocation_otherconsiderations",
          "text": "Other considerations:",
          "type": "string"
        }
      ]
    },
    {
      "extension": [
        {
          "extension": [
            {
              "url": "sortIndex",
              "valuePositiveInt": 13
            },
            {
              "url": "listSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "lastSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "style",
              "valueString": "font-weight:bold;"
            },
            {
              "url": "groupItems",
              "valueBoolean": false
            }
          ],
          "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"
        }
      ],
      "linkId": "supportingdocumentation_header",
      "text": "Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.",
      "_text": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "<b>Supporting&#xa0;Documentation</b><br/>Please&#xa0;attach&#xa0;all&#xa0;<b><span style=\"text-decoration: underline\">relevant</span></b>&#xa0;laboratory&#xa0;and&#xa0;diagnostic&#xa0;investigations."
          }
        ]
      },
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "check-box",
                    "display": "Check-box"
                  }
                ]
              }
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode": "horizontal"
            },
            {
              "extension": [
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "suppressQuestionText",
                  "valueBoolean": true
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "supportingdocumentation_details",
          "text": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient.",
          "_text": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString": "display:none;"
              }
            ]
          },
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "valueCoding": {
                "display": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient."
              }
            }
          ]
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "application/pdf"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "image/gif"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "image/bmp"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "video/mp4"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "text/csv"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "image/jpeg"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "application/msword"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "image/png"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "application/vnd.ms-excel"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "text/plain"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "audio/mp4"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "audio/mpeg"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
          "valueCode": "image/tiff"
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/maxSize",
          "valueDecimal": 1024000
        },
        {
          "extension": [
            {
              "url": "sortIndex",
              "valuePositiveInt": 14
            },
            {
              "url": "sameLine",
              "valueBoolean": false
            },
            {
              "url": "quoteAnswer",
              "valueBoolean": false
            }
          ],
          "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
        }
      ],
      "linkId": "supportingdocumentation_attachment",
      "text": "Add Attachments",
      "type": "attachment"
    },
    {
      "linkId": "feedbacksurvey_universal",
      "text": "Click here to provide feedback on this form",
      "_text": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "<a href=\"https://www.surveymonkey.com/r/universalSRF\">Click&#xa0;here&#xa0;to&#xa0;provide&#xa0;feedback&#xa0;on&#xa0;this&#xa0;form</a>"
          }
        ]
      },
      "type": "display"
    },
    {
      "extension": [
        {
          "extension": [
            {
              "url": "sortIndex",
              "valuePositiveInt": 15
            },
            {
              "url": "text",
              "valueString": "Referrer's Information"
            },
            {
              "url": "listSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "lastSeparator",
              "_valueString": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString": "<br/>"
                  }
                ]
              }
            },
            {
              "url": "style",
              "valueString": "font-weight:bold;text-decoration:underline;"
            },
            {
              "url": "groupItems",
              "valueBoolean": false
            }
          ],
          "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"
        }
      ],
      "linkId": "referrer_header",
      "text": "Referrer's Information",
      "_text": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString": "font-weight:bold;"
          }
        ]
      },
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Site Name"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_sitename",
          "text": "Site Name:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Address (Line 1)"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_address_line1",
          "text": "Address (Line 1):",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Address (Line 2)"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_address_line2",
          "text": "Address (Line 2):",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "City"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_address_city",
          "text": "City:",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Province"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_address_province",
          "text": "Province:",
          "type": "string",
          "required": true,
          "maxLength": 2
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "postalcode2"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='referrer_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Must be a valid Canadian postal code"
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Postal Code"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_address_postalcode",
          "text": "Postal Code:",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "phone5"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='referrer_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Phone #"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_phone",
          "text": "Phone #:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "key",
                  "valueId": "phone6"
                },
                {
                  "url": "severity",
                  "valueCode": "error"
                },
                {
                  "url": "expression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "%resource.repeat(item).where(linkId='referrer_fax').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url": "human",
                  "valueString": "Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX."
                }
              ],
              "url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Fax #"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_fax",
          "text": "Fax #:",
          "type": "string"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Billing Number"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_billing",
          "text": "Billing Number:",
          "type": "integer"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Professional ID"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_professionalid",
          "text": "Professional ID:",
          "type": "integer"
        },
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Signed"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_signature",
          "text": "Signed:",
          "type": "text",
          "required": true
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
              "valueUrl": "https://tx.fhir.org/r4"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "drop-down",
                    "display": "Drop down"
                  }
                ]
              }
            },
            {
              "extension": [
                {
                  "url": "text",
                  "valueString": "Role"
                },
                {
                  "url": "sameLine",
                  "valueBoolean": false
                },
                {
                  "url": "quoteAnswer",
                  "valueBoolean": false
                },
                {
                  "url": "style",
                  "valueString": "font-weight:bold;"
                }
              ],
              "url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"
            }
          ],
          "linkId": "referrer_role",
          "text": "Role:",
          "type": "choice",
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "309398001",
                "display": "Profession allied to medicine"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "62247001",
                "display": "Family doctor"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "449161006",
                "display": "Physician assistant"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "398130009",
                "display": "Medical student"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "106292003",
                "display": "Nurse"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "224571005",
                "display": "Nurse practitioner"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "405277009",
                "display": "Resident physician"
              }
            },
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "69280009",
                "display": "Specialized physician"
              }
            },
            {
              "valueCoding": {
                "display": "Other"
              }
            }
          ]
        }
      ]
    }
  ]
}