<status value="active" /> <experimental value="true" /> <subjectType value="Patient" /> <item> <linkId value="mainSection__section" /> <type value="group" /> <required value="true" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="body" /> <type value="group" /> <required value="true" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="id_102173268919_ocean_section" /> <type value="group" /> <required value="true" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="Referral Details"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Referral Details<br/>" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="id_102173268919" /> <text value="Referral Details"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> <item> <linkId value="id_306135170795_ocean_section" /> <type value="group" /> <required value="true" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="Triage Considerations" /> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="id_306135170795" /> <text value="Triage Considerations"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> <item> <linkId value="referral_requestedpriority_ocean_section" /> <type value="group" /> <required value="true" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#EE6B00;" /> </extension> </extension> <linkId value="referral_requestedpriority" /> <text value="Requested Priority:" /> <type value="string" /> <required value="true" /> <repeats value="false" /> <answerOption> <valueString value="Urgent" /> </answerOption> <answerOption> <valueString value="Routine" /> <initialSelected value="true" /> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="referral_requestedpriority_urgentreason_ocean_section" /> <type value="group" /> <enableWhen> <question value="referral_requestedpriority" /> <operator value="=" /> <answerString value="Urgent" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Reason for urgent triage:" /> </extension> </extension> <linkId value="referral_requestedpriority_urgentreason" /> <text value="Reason for urgent triage:" /> <type value="string" /> <required value="true" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Second Opinion" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="referral_secondopinion" /> <text value="Second Opinion" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="referral_secondopinion_reason_ocean_section" /> <type value="group" /> <enableWhen> <question value="referral_secondopinion" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Reason for second opinion:" /> </extension> </extension> <linkId value="referral_secondopinion_reason" /> <text value="Reason for second opinion:" /> <type value="text" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item64645035" /> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item56775351" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/variable"> <valueExpression> <name value="id-695991571585-ocean-section-hasAnswers" /> <language value="text/fhirpath" /> <expression value="item.where(answer.value.allTrue()).exists()" /> </valueExpression> </extension> <linkId value="id_695991571585_ocean_section" /> <type value="group" /> <required value="true" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="Service(s) Requested" /> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="id_695991571585" /> <text value="Service(s) Requested* Select all that apply:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Service(s) Requested*</b><br/><i>Select all that apply:</i>" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="ScriptUtil.sum(id_695991571585_ocean_section) == 0" /> <language value="text/fhirpath" /> <expression value="%`id-695991571585-ocean-section-hasAnswers`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item56775351" /> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Cardiac Testing" /> </extension> </extension> <linkId value="id_223886162384" /> <text value="Cardiac Testing" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/variable"> <valueExpression> <name value="id-660331267409-ocean-section-hasAnswers" /> <language value="text/fhirpath" /> <expression value="item.where(answer.value.allTrue()).exists()" /> </valueExpression> </extension> <linkId value="id_660331267409_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_223886162384" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="(id_223886162384.r == 'Y' ? 'Cardiac Testing' : '') == 'Cardiac Testing'" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='id_223886162384').answer.value" /> </valueExpression> </extension> <extension url="text"> <valueString value="• Exam(s) Requested:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="&#xa0;&#xa0;&#xa0;&#xa0;• <b>Exam(s) Requested:</b>" /> </extension> </valueString> </extension> </extension> <linkId value="id_660331267409" /> <text value="Exam(s) Requested *"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Exam(s) Requested</b> *" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• 24 Hour Ambulatory Blood Pressure Monitoring (Not OHIP Covered)" /> </extension> </extension> <linkId value="id_720409326878" /> <text value="24 Hour Ambulatory Blood Pressure Monitoring (Not OHIP Covered)" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Coronary Angiogram" /> </extension> </extension> <linkId value="id_960455115596" /> <text value="Coronary Angiogram" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Echocardiogram - Resting" /> </extension> </extension> <linkId value="id_297634898828" /> <text value="Echocardiogram - Resting" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="id_443484577720_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_297634898828" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Echocardiogram (2D)" /> </extension> </extension> <linkId value="id_165530569567" /> <text value="Echocardiogram (2D)" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Echocardiogram with Contrast" /> </extension> </extension> <linkId value="id_286552421895" /> <text value="Echocardiogram with Contrast" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Echocardiogram with Saline (Bubble)" /> </extension> </extension> <linkId value="id_910527687300" /> <text value="Echocardiogram with Saline (Bubble)" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Pediatric Echocardiogram" /> </extension> </extension> <linkId value="id_657824763133" /> <text value="Pediatric Echocardiogram" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Transesophageal Echocardiogram (TEE)" /> </extension> </extension> <linkId value="id_992743200182" /> <text value="Transesophageal Echocardiogram (TEE)" /> <type value="boolean" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Electrocardiogram (ECG)" /> </extension> </extension> <linkId value="id_894277763438" /> <text value="Electrocardiogram (ECG)" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Holter Monitoring" /> </extension> </extension> <linkId value="id_279226023495" /> <text value="Holter Monitoring" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="id_440449731882_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_279226023495" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• 24 Hours" /> </extension> </extension> <linkId value="id_671328703851" /> <text value="24 Hours" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• 48 Hours" /> </extension> </extension> <linkId value="id_423992261841" /> <text value="48 Hours" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• 72 Hours" /> </extension> </extension> <linkId value="id_419924239187" /> <text value="72 Hours" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• 7 Days" /> </extension> </extension> <linkId value="id_731054417270" /> <text value="7 Days" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• 14 Days" /> </extension> </extension> <linkId value="id_235876421044" /> <text value="14 Days" /> <type value="boolean" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Loop / Event Monitor" /> </extension> </extension> <linkId value="id_374742834400" /> <text value="Loop / Event Monitor" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Stress Testing" /> </extension> </extension> <linkId value="id_159161544747" /> <text value="Stress Testing" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="id_370275060390_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_159161544747" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• ECG - Exercise Stress Test" /> </extension> </extension> <linkId value="id_814218498309" /> <text value="ECG - Exercise Stress Test" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• ECG - Dobutamine/Persantine Stress Test" /> </extension> </extension> <linkId value="id_307107493993" /> <text value="ECG - Dobutamine/Persantine Stress Test" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Echocardiogram - Exercise Stress Test" /> </extension> </extension> <linkId value="id_805303414102" /> <text value="Echocardiogram - Exercise Stress Test" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Echocardiogram - Dobutamine/Persantine Stress Test" /> </extension> </extension> <linkId value="id_193586908489" /> <text value="Echocardiogram - Dobutamine/Persantine Stress Test" /> <type value="boolean" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Nuclear Medicine" /> </extension> </extension> <linkId value="id_918517139023" /> <text value="Nuclear Medicine" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="id_222686221935_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_918517139023" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• MUGA - Resting" /> </extension> </extension> <linkId value="id_924189648184" /> <text value="MUGA - Resting" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Cardiac Pyrophosphate" /> </extension> </extension> <linkId value="id_857163514910" /> <text value="Cardiac Pyrophosphate" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• MIBI Scans / Myocardial Perfusion Imaging (MPI)" /> </extension> </extension> <linkId value="id_892165959617" /> <text value="MIBI Scans / Myocardial Perfusion Imaging (MPI)" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="id_538288549138_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_892165959617" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• MIBI Scan - Exercise Stress Test" /> </extension> </extension> <linkId value="id_373435981917" /> <text value="MIBI Scan - Exercise Stress Test" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• MIBI Scan - Dobutamine/Persantine Stress Test" /> </extension> </extension> <linkId value="id_434394942688" /> <text value="MIBI Scan - Dobutamine/Persantine Stress Test" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Thallium Viability Test" /> </extension> </extension> <linkId value="id_913594478162" /> <text value="Thallium Viability Test" /> <type value="boolean" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Tilt Table Testing" /> </extension> </extension> <linkId value="id_992682216482" /> <text value="Tilt Table Testing" /> <type value="boolean" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Cardiology Consultation" /> </extension> </extension> <linkId value="id_785727177547" /> <text value="Cardiology Consultation" /> <type value="boolean" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item52721939" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/variable"> <valueExpression> <name value="id-186952778859-ocean-section-hasAnswers" /> <language value="text/fhirpath" /> <expression value="item.where(answer.value.allTrue()).exists()" /> </valueExpression> </extension> <linkId value="id_186952778859_ocean_section" /> <type value="group" /> <required value="true" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="Concern(s) / Indication(s) Triggering Referral"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<br/>Concern(s) / Indication(s) Triggering Referral" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="id_186952778859" /> <text value="Concern(s) / Indication(s) Triggering Referral* Select all that apply:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Concern(s) / Indication(s) Triggering Referral*</b><br/><i>Select all that apply:</i>" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="ScriptUtil.sum(id_186952778859_ocean_section) == 0" /> <language value="text/fhirpath" /> <expression value="%`id-186952778859-ocean-section-hasAnswers`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item52721939" /> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Arrythmias or Palpitations" /> </extension> </extension> <linkId value="id_219569805461" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Arrythmias or Palpitations" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Cardiovascular Risk Assessment" /> </extension> </extension> <linkId value="id_571934328499" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Cardiovascular Risk Assessment" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Chest Pain or Angina" /> </extension> </extension> <linkId value="id_459737733395" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Chest Pain or Angina" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Congenital Heart Disease" /> </extension> </extension> <linkId value="id_929919815516" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Congenital Heart Disease" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Congestive Heart Failure" /> </extension> </extension> <linkId value="id_832263816528" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Congestive Heart Failure" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Coronary Artery Disease" /> </extension> </extension> <linkId value="id_803760213460" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Coronary Artery Disease" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Dyspnea" /> </extension> </extension> <linkId value="id_129767162379" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Dyspnea" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Hypertension" /> </extension> </extension> <linkId value="id_116150628533" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Hypertension" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Murmur" /> </extension> </extension> <linkId value="id_513825527027" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Murmur" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Pericardial Disease" /> </extension> </extension> <linkId value="id_975075898688" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Pericardial Disease" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Peripheral Edema" /> </extension> </extension> <linkId value="id_704148928571" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Peripheral Edema" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Post-Myocardial Infarction" /> </extension> </extension> <linkId value="id_886489617115" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Post-Myocardial Infarction" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Pre-Operative Consultation" /> </extension> </extension> <linkId value="id_621745958993" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Pre-Operative Consultation" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="id_873024527134_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_621745958993" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Procedure Date:" /> </extension> </extension> <linkId value="id_873024527134" /> <text value="Procedure Date (if known)" /> <type value="date" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Syncope" /> </extension> </extension> <linkId value="id_197975129599" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Syncope" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Valvular Heart Disease or Prosthetic Heart Valve" /> </extension> </extension> <linkId value="id_675849150752" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Valvular Heart Disease or Prosthetic Heart Valve" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Other" /> </extension> </extension> <linkId value="id_721982740516" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Other" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="id_720594942482_ocean_section" /> <type value="group" /> <enableWhen> <question value="id_721982740516" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Specify:" /> </extension> </extension> <linkId value="id_720594942482" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Specify:" /> <type value="text" /> <required value="true" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item66721068" /> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Brief Description of Referral, History, Management, and Investigations:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Brief Description of Referral, History, Management, and Investigations:<br/>" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="id_127224908991" /> <text value="Brief Description of Referral, History, Management, and Investigations"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="text" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item73913434" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="cpp_header_ocean_section" /> <type value="group" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="cpp_separate.r == 'Y' || cpp_currentprob.r != '' || cpp_pastmedicalhistory.r != '' || cpp_currentmedications.r != '' || cpp_familyhistory.r != '' || cpp_allergies.r != ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='cpp_separate').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='cpp_currentprob').answer.exists() or %resource.repeat(item).where(linkId='cpp_pastmedicalhistory').answer.exists() or %resource.repeat(item).where(linkId='cpp_currentmedications').answer.exists() or %resource.repeat(item).where(linkId='cpp_familyhistory').answer.exists() or %resource.repeat(item).where(linkId='cpp_allergies').answer.exists()" /> </valueExpression> </extension> <extension url="text"> <valueString value="Cumulative Patient Profile"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Cumulative Patient Profile<br/>" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="cpp_header" /> <text value="Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Cumulative Patient Profile<br/><i>Please delete any sensitive information you do not intend to share from the CPP</i>" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• CPP attached separately" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="cpp_separate" /> <text value="CPP attached separately (if not entered below)" /> <type value="boolean" /> </item> <item> <linkId value="cpp_currentprob_ocean_section" /> <type value="group" /> <enableWhen> <question value="cpp_separate" /> <operator value="!=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.prob`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Current Problem List:" /> </extension> </extension> <linkId value="cpp_currentprob" /> <definition value="urn:uri:ontariolegacy:problemList" /> <text value="Current Problem List:" /> <type value="text" /> </item> </item> <item> <linkId value="cpp_pastmedicalhistory_ocean_section" /> <type value="group" /> <enableWhen> <question value="cpp_separate" /> <operator value="!=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.pmhx`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Past Medical History:" /> </extension> </extension> <linkId value="cpp_pastmedicalhistory" /> <definition value="urn:uri:ontariolegacy:pastMedicalHistory" /> <text value="Past Medical History:" /> <type value="text" /> </item> </item> <item> <linkId value="cpp_currentmedications_ocean_section" /> <type value="group" /> <enableWhen> <question value="cpp_separate" /> <operator value="!=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.rx`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Current Medications:" /> </extension> </extension> <linkId value="cpp_currentmedications" /> <definition value="urn:uri:ontariolegacy:medications" /> <text value="Current Medications:" /> <type value="text" /> </item> </item> <item> <linkId value="cpp_familyhistory_ocean_section" /> <type value="group" /> <enableWhen> <question value="cpp_separate" /> <operator value="!=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.fhx`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Family History:" /> </extension> </extension> <linkId value="cpp_familyhistory" /> <definition value="urn:uri:ontariolegacy:familyHistory" /> <text value="Family History:" /> <type value="text" /> </item> </item> <item> <linkId value="cpp_allergies_ocean_section" /> <type value="group" /> <enableWhen> <question value="cpp_separate" /> <operator value="!=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.allg`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Allergies:" /> </extension> </extension> <linkId value="cpp_allergies" /> <definition value="urn:uri:ontariolegacy:allergies" /> <text value="Allergies:" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item4352029" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="preferredconsultlocation_header_ocean_section" /> <type value="group" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="preferredconsultlocation_selector.r == 'Y' || preferredconsultlocation_willingtotravel.r == 'Y' || preferredconsultlocation_otherconsiderations.r != ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='preferredconsultlocation_selector').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='preferredconsultlocation_willingtotravel').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='preferredconsultlocation_otherconsiderations').answer.exists()" /> </valueExpression> </extension> <extension url="text"> <valueString value="Preferred Consultant or Location"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Preferred Consultant or Location<br/>" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="preferredconsultlocation_header" /> <text value="Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered."> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Preferred Consultant or Location</b><br/>All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered." /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Preferred consultant or location" /> </extension> </extension> <linkId value="preferredconsultlocation_selector" /> <text value="Preferred consultant or location"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Preferred</b> consultant or location" /> </extension> </text> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="preferredconsultlocation_specify_ocean_section" /> <type value="group" /> <enableWhen> <question value="preferredconsultlocation_selector" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="preferredconsultlocation_specify" /> <text value="Please specify either a preferred consultant or location"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Please specify either a <b>preferred</b> consultant or location" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Consultant:" /> </extension> </extension> <linkId value="preferredconsultlocation_consultant" /> <text value="Consultant:" /> <type value="string" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Location:" /> </extension> </extension> <linkId value="preferredconsultlocation_location" /> <text value="Location:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Patient willing to travel for shorter wait time" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="preferredconsultlocation_willingtotravel" /> <text value="Patient willing to travel for shorter wait time" /> <type value="boolean" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Other considerations:" /> </extension> </extension> <linkId value="preferredconsultlocation_otherconsiderations" /> <text value="Other considerations:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="additionalinfo_header_ocean_section" /> <type value="group" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="additionalinfo_sexassignedatbirth.r != '' || additionalinfo_pronouns.r != '' || additionalinfo_preferredlanguage.r != '' || additionalinfo_bestmethodofcontact.r != '' || additionalinfo_preferredname_select.r != '' || additionalinfo_alternatecontact_select.r != '' || additionalinfo_unsafecontacts_select.r != '' || additionalinfo_accessibilityconcernsordisability_select.r != '' || additionalinfo_specialconsiderations_select.r != ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='additionalinfo_sexassignedatbirth').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_pronouns').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_preferredlanguage').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_bestmethodofcontact').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_preferredname_select').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_alternatecontact_select').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_unsafecontacts_select').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_accessibilityconcernsordisability_select').answer.exists() or %resource.repeat(item).where(linkId='additionalinfo_specialconsiderations_select').answer.exists()" /> </valueExpression> </extension> <extension url="text"> <valueString value="[Optional] Additional Patient Information"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<br/>[Optional] Additional Patient Information<br/>" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="additionalinfo_header" /> <text value="[Optional] Additional Patient Information"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="additionalinfo_sexassignedatbirth" /> <text value="Sex assigned at birth:" /> <type value="string" /> <repeats value="false" /> <answerOption> <valueString value="Female" /> </answerOption> <answerOption> <valueString value="Male" /> </answerOption> <answerOption> <valueString value="Intersex" /> </answerOption> <answerOption> <valueString value="Unknown" /> </answerOption> </item> <item> <linkId value="additionalinfo_pronouns_ocean_section" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="additionalinfo_pronouns" /> <text value="Pronouns:" /> <type value="string" /> <repeats value="false" /> <answerOption> <valueString value="She/Her" /> </answerOption> <answerOption> <valueString value="He/Him" /> </answerOption> <answerOption> <valueString value="They/Them" /> </answerOption> <answerOption> <valueString value="Other" /> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_pronouns_other_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_pronouns" /> <operator value="=" /> <answerString value="Other" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Other pronouns:" /> </extension> </extension> <linkId value="additionalinfo_pronouns_other" /> <text value="Other pronouns:" /> <type value="string" /> <required value="true" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="additionalinfo_preferredname.r == '' && additionalinfo_preferredname_select.r == 'Y'" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='additionalinfo_preferredname').answer.empty() and %resource.repeat(item).where(linkId='additionalinfo_preferredname_select').answer.exists(value = 'Y')" /> </valueExpression> </extension> <extension url="positiveText"> <valueString value="• Preferred Name" /> </extension> </extension> <linkId value="additionalinfo_preferredname_select" /> <text value="Preferred Name" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_preferredname_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_preferredname_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Preferred Name:" /> </extension> </extension> <linkId value="additionalinfo_preferredname" /> <type value="string" /> </item> </item> <item> <linkId value="additionalinfo_preferredlanguage_ocean_section" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="additionalinfo_preferredlanguage" /> <text value="Preferred language:" /> <type value="string" /> <repeats value="false" /> <answerOption> <valueString value="English" /> </answerOption> <answerOption> <valueString value="French" /> </answerOption> <answerOption> <valueString value="Other" /> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_preferredlanguage_specify_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_preferredlanguage" /> <operator value="=" /> <answerString value="Other" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Specify:" /> </extension> </extension> <linkId value="additionalinfo_preferredlanguage_specify" /> <text value="Specify:" /> <type value="string" /> <required value="true" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_preferredlanguage_translatorrequired_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_preferredlanguage" /> <operator value="=" /> <answerString value="Other" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Translator required" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="additionalinfo_preferredlanguage_translatorrequired" /> <text value="Translator Required" /> <type value="boolean" /> </item> </item> </item> <item> <linkId value="additionalinfo_bestmethodofcontact_ocean_section" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="additionalinfo_bestmethodofcontact" /> <text value="Best method of contact:" /> <type value="string" /> <repeats value="false" /> <answerOption> <valueString value="Mobile" /> </answerOption> <answerOption> <valueString value="Home" /> </answerOption> <answerOption> <valueString value="Business" /> </answerOption> <answerOption> <valueString value="Email" /> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_bestmethodofcontact_voicemails_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_bestmethodofcontact" /> <operator value="=" /> <answerString value="Mobile" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Voicemails acceptable" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#008800;" /> </extension> </extension> <linkId value="additionalinfo_bestmethodofcontact_voicemails" /> <text value="Voicemails acceptable" /> <type value="boolean" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Alternate contact" /> </extension> </extension> <linkId value="additionalinfo_alternatecontact_select" /> <text value="Alternate contact" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_alternatecontact_name_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_alternatecontact_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Name:" /> </extension> </extension> <linkId value="additionalinfo_alternatecontact_name" /> <text value="Name:" /> <type value="string" /> <required value="true" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_alternatecontact_phone_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_alternatecontact_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Alternate contact phone #:" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="additionalinfo-alternatecontact-phone" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX." /> </extension> <extension url="expression"> <valueExpression> <language value="text/fhirpath" /> <expression value="answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" /> </valueExpression> </extension> </extension> <linkId value="additionalinfo_alternatecontact_phone" /> <text value="Alternate contact phone #:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_alternatecontact_relationship_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_alternatecontact_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Relationship:" /> </extension> </extension> <linkId value="additionalinfo_alternatecontact_relationship" /> <text value="Relationship:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_alternatecontact_bookingcontact_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_alternatecontact_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="positiveText"> <valueString value="• Alternate contact is the booking contact" /> </extension> <extension url="negativeText"> <valueString value="• Alternate contact is not the booking contact" /> </extension> </extension> <linkId value="additionalinfo_alternatecontact_bookingcontact" /> <text value="Is Alternate contact the appointment booking contact?:" /> <type value="choice" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Unsafe contact persons (do not speak with)" /> </extension> </extension> <linkId value="additionalinfo_unsafecontacts_select" /> <text value="Unsafe contact persons (do not speak with)"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Unsafe contact persons <b>(do not speak with)</b>" /> </extension> </text> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_unsafecontacts_speakwithpatientdirectly_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_unsafecontacts_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Only speak with patient directly" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="additionalinfo_unsafecontacts_speakwithpatientdirectly" /> <text value="Only speak with patient directly" /> <type value="boolean" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_unsafecontacts_donotspeakwith_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_unsafecontacts_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Do not speak with:" /> </extension> </extension> <linkId value="additionalinfo_unsafecontacts_donotspeakwith" /> <text value="Do not speak with:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Accessibility concerns or disability" /> </extension> </extension> <linkId value="additionalinfo_accessibilityconcernsordisability_select" /> <text value="Accessibility concerns or disability" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_accessibilityconcernsordisability_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_accessibilityconcernsordisability_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="•" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#EE6B00;" /> </extension> </extension> <linkId value="additionalinfo_accessibilityconcernsordisability" /> <type value="string" /> <repeats value="true" /> <answerOption> <valueString value="Falls risk" /> </answerOption> <answerOption> <valueString value="Patient requires lift" /> </answerOption> <answerOption> <valueString value="Wheelchair" /> </answerOption> <answerOption> <valueString value="Hearing impaired" /> </answerOption> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)" /> </extension> </extension> <linkId value="additionalinfo_specialconsiderations_select" /> <text value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Special considerations <i>(e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</i>" /> </extension> </text> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="additionalinfo_specialconsiderations_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_specialconsiderations_select" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Details:" /> </extension> </extension> <linkId value="additionalinfo_specialconsiderations" /> <text value="Details of special considerations:" /> <type value="text" /> <required value="true" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Send copies of reports to additional providers"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<br/>Send copies of reports to additional providers" /> </extension> </valueString> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders" /> <text value="Send copies of reports to additional providers" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="border-style:solid;" /> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders_names_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_sendcopiestoadditionalproviders" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Additional provider name(s):" /> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders_names" /> <text value="Name(s):" /> <type value="string" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="border-style:solid;" /> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders_contactinfo_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_sendcopiestoadditionalproviders" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Contact information:" /> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders_contactinfo" /> <text value="Contact information:" /> <type value="string" /> <required value="true" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="border-style:solid;" /> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders_ispcp_ocean_section" /> <type value="group" /> <enableWhen> <question value="additionalinfo_sendcopiestoadditionalproviders" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#0000AA;" /> </extension> </extension> <linkId value="additionalinfo_sendcopiestoadditionalproviders_ispcp" /> <text value="This is the Primary Care Provider" /> <type value="boolean" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item63777732" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="supportingdocumentation_header_ocean_section" /> <type value="group" /> <item> <linkId value="supportingdocumentation_header" /> <text value="Supporting Documentation Please attach all relevant laboratory and diagnostic investigations."> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Supporting Documentation</b><br/>Please attach all <b><span style="text-decoration:underline;">relevant</span></b> laboratory and diagnostic investigations." /> </extension> </text> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <linkId value="feedbacksurvey_cardiology" /> <text value="Click here to provide feedback on this form"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="text-decoration:underline;" /> </extension> </text> <type value="display" /> </item> </item> </item> </Questionnaire>