<status value="active" /> <experimental value="false" /> <subjectType value="Patient" /> <item> <linkId value="KidneyWiseForm" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;" /> </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" /> <item> <linkId value="item47143865" /> <text value="* Indicates a required field"> <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/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="AdditionalPatientInfo" /> <text value="Additional Patient Information"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptLanguage`" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="PreferredLanguage.r.includes('English') || PreferredLanguage.r.includes('French') == true" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='PreferredLanguage').answer.value.contains('English') or %resource.repeat(item).where(linkId='PreferredLanguage').answer.value.contains('French') = true" /> </valueExpression> </extension> <extension url="text"> <valueString value="Preferred Language:" /> </extension> </extension> <linkId value="PreferredLanguage" /> <text value="Preferred Language:" /> <type value="choice" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_PreferredLanguage" /> <code value="eng" /> <display value="eng" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_PreferredLanguage" /> <code value="fre" /> <display value="fre" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_PreferredLanguage" /> <code value="Other" /> <display value="Other" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptLanguage`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Preferred Language:" /> </extension> </extension> <linkId value="item55155068" /> <text value="Preferred Language" /> <type value="string" /> <enableWhen> <question value="PreferredLanguage" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item55155068" /> <code value="Other" /> <display value="Other" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="PreferredLanguage.r.includes('Other') == true" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='PreferredLanguage').answer.value.contains('Other') = true" /> </valueExpression> </extension> <extension url="text"> <valueString value="Translator NOT needed"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Translator NOT needed" /> </extension> </valueString> </extension> <extension url="positiveText"> <valueString value="Translator needed"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Translator needed" /> </extension> </valueString> </extension> </extension> <linkId value="Translator" /> <text value="Translator Required" /> <type value="boolean" /> <enableWhen> <question value="PreferredLanguage" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Translator" /> <code value="Other" /> <display value="Other" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptPmoc`" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Best Method of Contact:" /> </extension> </extension> <linkId value="BestContactMethod" /> <text value="Best Method of Contact:" /> <type value="choice" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" /> <code value="OTHER" /> <display value="OTHER" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" /> <code value="HOME" /> <display value="HOME" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" /> <code value="BUSINESS" /> <display value="BUSINESS" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" /> <code value="EMAIL" /> <display value="EMAIL" /> </valueCoding> </answerOption> </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="BestContactMethod.r.includes('OTHER') || BestContactMethod.r.includes('HOME') || BestContactMethod.r.includes('BUSINESS')== true" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='BestContactMethod').answer.value.contains('OTHER') or %resource.repeat(item).where(linkId='BestContactMethod').answer.value.contains('HOME') or %resource.repeat(item).where(linkId='BestContactMethod').answer.value.contains('BUSINESS')= true" /> </valueExpression> </extension> <extension url="text"> <valueString value="Voicemail acceptable: No" /> </extension> <extension url="positiveText"> <valueString value="Voicemail acceptable: Yes" /> </extension> </extension> <linkId value="item73068595" /> <text value="Voicemails acceptable" /> <type value="boolean" /> <enableWhen> <question value="BestContactMethod" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item73068595" /> <code value="OTHER" /> <display value="OTHER" /> </answerCoding> </enableWhen> <enableWhen> <question value="BestContactMethod" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item73068595" /> <code value="HOME" /> <display value="HOME" /> </answerCoding> </enableWhen> <enableWhen> <question value="BestContactMethod" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item73068595" /> <code value="BUSINESS" /> <display value="BUSINESS" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> </item> <item> <linkId value="item95810306" /> <text value="Where appropriate, please provide:" /> <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="Appointment booking contact" /> </extension> <extension url="style"> <valueString value="text-decoration:underline;" /> </extension> </extension> <linkId value="AlternateContact" /> <text value="Appointment booking contact (if not patient)" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptEmergencyContact`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Name:" /> </extension> </extension> <linkId value="item6554535" /> <text value="Contact Name:" /> <type value="string" /> <enableWhen> <question value="AlternateContact" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptEmergencyContactPhone`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Phone Number:" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item80027355" /> </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="item80027355" /> <text value="Phone Number (if different than patient):" /> <type value="string" /> <enableWhen> <question value="AlternateContact" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> <extension url="text"> <valueString value="Special Considerations:" /> </extension> </extension> <linkId value="SpecialConsiderations" /> <text value="Special considerations (3rd party insurance, accessibility, barriers, tips for care delivery)" /> <type value="boolean" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Special Considerations: {{answer}}" /> </extension> </extension> <linkId value="item38347402" /> <text value="Details of special considerations:" /> <type value="text" /> <enableWhen> <question value="SpecialConsiderations" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item25397237" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item10476570" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="ScriptUtil.percentComplete( PreferredLoc) != 0" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='PreferredLoc').select(item.where(linkId='item10476570').exists(answer) | item.where(linkId='section95718570').exists(answer) | item.where(linkId='item74312441').exists(answer)).count() * 100 / 3 != 0" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Preferred Location(s)" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="PreferredLoc" /> <text value="Preferred Location(s) *" /> <type value="group" /> <item> <linkId value="item10476570" /> <text value="Select all that apply:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Select all that apply:" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="section95718570" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item7852115" /> <text value="Hamilton" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;" /> </extension> <linkId value="section31627363" /> <type value="group" /> <enableWhen> <question value="item7852115" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item42030680" /> <text value="Telephone: 905 529 2259 Fax: 905 529 2262"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Telephone: 905 529 2259 Fax: 905 529 2262" /> </extension> </text> <type value="display" /> </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> <linkId value="item59448874" /> <text value="St. Catharines" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;" /> </extension> <linkId value="section55723098" /> <type value="group" /> <enableWhen> <question value="item59448874" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item90358461" /> <text value="Telephone: 905 529 2259 Fax: 905 529 2262"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Telephone: 905 529 2259 Fax: 905 529 2262" /> </extension> </text> <type value="display" /> </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> <linkId value="item44065286" /> <text value="Cambridge Memorial Hospital" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;" /> </extension> <linkId value="section18070968" /> <type value="group" /> <enableWhen> <question value="item44065286" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item8918930" /> <text value="Telephone: 905 529 2259 Fax: 905 529 2262"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Telephone: 905 529 2259 Fax: 905 529 2262" /> </extension> </text> <type value="display" /> </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="item74312441" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item3508830" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="ScriptUtil.percentComplete( section9816307) != 0" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='section9816307').select(item.where(linkId='item53780705').exists(answer) | item.where(linkId='section68958263').exists(answer) | item.where(linkId='item3508830').exists(answer)).count() * 100 / 3 != 0" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Service Request(s)" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="section9816307" /> <text value="Service Request(s) *" /> <type value="group" /> <item> <linkId value="item3508830" /> <text value="Select all that apply:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Select all that apply:" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="section68958263" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item45390734.r==''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='item45390734').answer.empty()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Sleep study; consult; treatment if required" /> </extension> </extension> <linkId value="item84731201" /> <text value="Sleep study; consult; treatment if required" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item84731201.r==''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='item84731201').answer.empty()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="• Diagnostic sleep study only, no consult, no treatment" /> </extension> </extension> <linkId value="item45390734" /> <text value="Diagnostic sleep study only, no consult, no treatment" /> <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="• Consult; followed by diagnosis and treatment if required" /> </extension> </extension> <linkId value="item46379923" /> <text value="Consult; followed by diagnosis and treatment if required" /> <type value="boolean" /> </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="item53780705" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Reason for Referral" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="reasonforreferralsec" /> <text value="Reason for Referral" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Urgency:" /> </extension> </extension> <linkId value="Urgency" /> <text value="Urgency:" /> <type value="choice" /> <required value="true" /> <repeats value="false" /> <answerOption> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"> <extension url="style"> <valueString value="font-weight:bold;color:#008800;" /> </extension> </extension> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Urgency" /> <code value="Routine" /> <display value="Routine" /> </valueCoding> <initialSelected value="true" /> </answerOption> <answerOption> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"> <extension url="style"> <valueString value="font-weight:bold;color:#EE6B00;" /> </extension> </extension> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Urgency" /> <code value="High Priority" /> <display value="High Priority" /> </valueCoding> </answerOption> <answerOption> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info"> <extension url="style"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Urgency" /> <code value="Urgent" /> <display value="Urgent" /> </valueCoding> </answerOption> </item> <item> <linkId value="item40810108" /> <text value="Rationale for Urgent Referral:" /> <type value="string" /> <enableWhen> <question value="Urgency" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item40810108" /> <code value="Urgent" /> <display value="Urgent" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item54277157" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="ScriptUtil.percentComplete( section75710709 ) != 0" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='section75710709').select(item.where(linkId='item54277157').exists(answer) | item.where(linkId='reason_for_referral').exists(answer)).count() * 100 / 2 != 0" /> </valueExpression> </extension> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Symptom(s) Leading to Referral" /> </extension> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="section75710709" /> <text value="Symptom(s) Leading to Referral *" /> <type value="group" /> <item> <linkId value="item54277157" /> <text value="Select all that apply:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-style:italic;" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="reason_for_referral" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="sortIndex"> <valuePositiveInt value="11" /> </extension> </extension> <linkId value="item72495479" /> <text value="Snoring" /> <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="sortIndex"> <valuePositiveInt value="12" /> </extension> </extension> <linkId value="item83826274" /> <text value="Snoring with apnea" /> <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="sortIndex"> <valuePositiveInt value="13" /> </extension> </extension> <linkId value="item3849613" /> <text value="Obesity" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Obesity Details" /> </extension> <extension url="style"> <valueString value="text-decoration:underline;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> <extension url="sortIndex"> <valuePositiveInt value="24" /> </extension> </extension> <linkId value="section27575149" /> <type value="group" /> <enableWhen> <question value="item3849613" /> <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/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item86156137" /> <text value="Height:" /> <type value="choice" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item86156137" /> <code value="cm" /> <display value="cm" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item86156137" /> <code value="ft" /> <display value="ft" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="htFeet" /> <text value="Feet:" /> <type value="choice" /> <enableWhen> <question value="item86156137" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="ft" /> <display value="ft" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="1'" /> <display value="1'" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="2'" /> <display value="2'" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="3'" /> <display value="3'" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="4" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="4'" /> <display value="4'" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="5" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="5'" /> <display value="5'" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="6" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="6'" /> <display value="6'" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="7" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htFeet" /> <code value="7'" /> <display value="7'" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="htInches" /> <text value="Inches:" /> <type value="choice" /> <enableWhen> <question value="item86156137" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="ft" /> <display value="ft" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="0"" /> <display value="0"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="1"" /> <display value="1"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="2"" /> <display value="2"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="3"" /> <display value="3"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="4" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="4"" /> <display value="4"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="5" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="5"" /> <display value="5"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="6" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="6"" /> <display value="6"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="7" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="7"" /> <display value="7"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="8" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="8"" /> <display value="8"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="9" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="9"" /> <display value="9"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="10" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="10"" /> <display value="10"" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="11" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" /> <code value="11"" /> <display value="11"" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptLatestVal.ht`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Height: {{answer}} cm" /> </extension> </extension> <linkId value="htCm" /> <text value="Height (cm):" /> <type value="decimal" /> <enableWhen> <question value="item86156137" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htCm" /> <code value="cm" /> <display value="cm" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item41557024" /> <text value="Weight:" /> <type value="choice" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item41557024" /> <code value="kg" /> <display value="kg" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item41557024" /> <code value="lb" /> <display value="lb" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptLatestVal.wt`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Weight: {{answer}} kg" /> </extension> </extension> <linkId value="wtKgs" /> <text value="Weight (kg):" /> <type value="decimal" /> <enableWhen> <question value="item41557024" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_wtKgs" /> <code value="kg" /> <display value="kg" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Weight: {{answer}} lb" /> </extension> </extension> <linkId value="wtLbs" /> <text value="Weight (lb):" /> <type value="decimal" /> <enableWhen> <question value="item41557024" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_wtLbs" /> <code value="lb" /> <display value="lb" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="(htCm.p!='' || (htFeet.p!='' && htInches.p!='')) && (wtLbs.p!='' || wtKgs.p!='')" /> <language value="text/fhirpath" /> <expression value="(%resource.repeat(item).where(linkId='htCm').answer.exists() or (%resource.repeat(item).where(linkId='htFeet').answer.value.weight()!='' and %resource.repeat(item).where(linkId='htInches').answer.value.weight()!='')) and (%resource.repeat(item).where(linkId='wtLbs').answer.exists() or %resource.repeat(item).where(linkId='wtKgs').answer.exists())" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="item41557024.p!='' && item86156137.p!=''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='item41557024').answer.value.weight()!='' and %resource.repeat(item).where(linkId='item86156137').answer.value.weight()!=''" /> </valueExpression> </extension> </extension> <linkId value="item45612156" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() { var ht = 0; var wt = 0; var BMI = 0; if (htCm.p != 0) { ht = htCm.p / 100; } else if (htFeet.p != 0 && htInches.p != '') { ht = (0.3048*htFeet.p) + (0.0254*htInches.p); } if (wtLbs.p && wtLbs.p != 0) { wt = wtLbs.p * 0.453592; } else { wt = wtKgs.p; } BMI = wt / (ht * ht); return Math.round(BMI*10/10); })();" /> <language value="text/fhirpath" /> <expression value="iif( %resource.item.where(linkId = 'htCm').answer.valueDecimal != 0, %resource.item.where(linkId = 'htCm').answer.valueDecimal / 100, iif( %resource.item.where(linkId = 'htFeet').answer.valueDecimal != 0 and %resource.item.where(linkId = 'htInches').answer.valueDecimal != '', (0.3048 * %resource.item.where(linkId = 'htFeet').answer.valueDecimal) + (0.0254 * %resource.item.where(linkId = 'htInches').answer.valueDecimal), 0 ) ).select( $this.power(-1).select( iif( %resource.item.where(linkId = 'wtLbs').answer.valueDecimal.exists() and %resource.item.where(linkId = 'wtLbs').answer.valueDecimal != 0, %resource.item.where(linkId = 'wtLbs').answer.valueDecimal * 0.453592, %resource.item.where(linkId = 'wtKgs').answer.valueDecimal ) * $this * $this ) ).round(0)" /> </valueExpression> </extension> </text> <type value="display" /> </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="sortIndex"> <valuePositiveInt value="14" /> </extension> </extension> <linkId value="item97391358" /> <text value="Unrefreshing sleep" /> <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="sortIndex"> <valuePositiveInt value="15" /> </extension> </extension> <linkId value="item49869991" /> <text value="Excessive daytime sleepiness" /> <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="sortIndex"> <valuePositiveInt value="16" /> </extension> </extension> <linkId value="item74170896" /> <text value="Frequent awakenings" /> <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="sortIndex"> <valuePositiveInt value="17" /> </extension> </extension> <linkId value="item9633588" /> <text value="Difficulty initiating or maintaining sleep" /> <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="sortIndex"> <valuePositiveInt value="18" /> </extension> </extension> <linkId value="item92573517" /> <text value="Restless legs" /> <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="sortIndex"> <valuePositiveInt value="19" /> </extension> </extension> <linkId value="item55426052" /> <text value="Unusual movement during sleep" /> <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="sortIndex"> <valuePositiveInt value="20" /> </extension> </extension> <linkId value="item22456535" /> <text value="Abnormal behaviour during sleep" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="item65409751.r=='Y' && item24344238.r==''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='item65409751').answer.exists(value = 'Y') and %resource.repeat(item).where(linkId='item24344238').answer.empty()" /> </valueExpression> </extension> <extension url="sortIndex"> <valuePositiveInt value="21" /> </extension> </extension> <linkId value="item65409751" /> <text value="Oxygen" /> 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url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.allg`" /> </valueExpression> </extension> <linkId value="item19532475" /> <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="item31368171" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> <extension url="listSeparator"> <valueString> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value=" " /> </extension> </valueString> </extension> </extension> <linkId value="section79119148" /> <text value="Supporting Documentation" /> <type value="group" /> <item> <linkId value="item89395197" /> <text value="Please attach all relevant laboratory and diagnostic investigations."> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Please attach all relevant laboratory and diagnostic investigations." /> </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="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item16476704" /> <text value="Please provide studies done at other laboratories" /> <type value="boolean" /> </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="item2601597" /> <type value="display" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="section98896179" /> <text value="Export Analytics [PSM NOT REVIEWED]" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="noAttachmentWarning" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="CPPAttachment.r == 'Y' ? 'Did you forget to attach a file?' : ''" /> <language value="text/fhirpath" /> <expression value="iif((%resource.repeat(item).where(linkId='CPPAttachment').answer.exists(value = 'Y') ), 'Did you forget to attach a file?', '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="referralService" /> <text value="SLEEP_MEDICINE" /> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="referralDescription" /> <text value="Sleep Disorder Clinic" /> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="ax_reasonForReferral" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() { var descs = []; 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var descs = ""; if (Urgency.r == 'Urgent') {descs+='Urgent' + '; ';} if (Urgency.p == '3') {descs+='High Priority' + '; ';} if (Urgency.r == 'Routine') {descs+='Routine' + '; ';} return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='Urgency').answer.exists(value = 'Urgent'),'Urgent' + '; ') | iif(%resource.repeat(item).where(linkId='Urgency').answer.value.weight() = '3','High Priority' + '; ') | iif(%resource.repeat(item).where(linkId='Urgency').answer.exists(value = 'Routine'),'Routine' + '; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="referrerUrgency" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (Urgency.r == 'Urgent') {descs+='Urgent' + '; ';} if (Urgency.p == '3') {descs+='SemiUrgent' + '; ';} if (Urgency.r == 'Routine') {descs+='Routine' + '; ';} return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='Urgency').answer.exists(value = 'Urgent'),'Urgent' + '; ') | iif(%resource.repeat(item).where(linkId='Urgency').answer.value.weight() = '3','SemiUrgent' + '; ') | iif(%resource.repeat(item).where(linkId='Urgency').answer.exists(value = 'Routine'),'Routine' + '; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="referralUrgency" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (Urgency.r == 'Urgent') {descs+='Urgent' + '; ';} if (Urgency.p == '3') {descs+='SemiUrgent' + '; ';} if (Urgency.r == 'Routine') {descs+='Routine' + '; ';} return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='Urgency').answer.exists(value = 'Urgent'),'Urgent' + '; ') | iif(%resource.repeat(item).where(linkId='Urgency').answer.value.weight() = '3','SemiUrgent' + '; ') | iif(%resource.repeat(item).where(linkId='Urgency').answer.exists(value = 'Routine'),'Routine' + '; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <linkId value="ax_diagnosis" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (item72495479.r == 'Y') {descs+='Snoring' + '; ';} if (item83826274.r == 'Y') {descs+='Snoring with apnea' + '; ';} if (item3849613.r == 'Y') {descs+='Obesity' + '; ';} if (item97391358.r == 'Y') {descs+='Unrefreshing sleep' + '; ';} if (item49869991.r == 'Y') {descs+='Excessive Daytime sleepiness' + '; ';} if (item74170896.r == 'Y') {descs+='Frequent awakenings' + '; ';} if (item9633588.r == 'Y') {descs+='Difficulty initiating or maintaining sleep' + '; ';} if (item92573517.r == 'Y') {descs+='Restless legs' + '; ';} if (item55426052.r == 'Y') {descs+='Unusual movement during sleep' + '; ';} if (item22456535.r == 'Y') {descs+='Abnormal behaviour during sleep' + '; ';} if (item65409751.r == 'Y') {descs+='Oxygen concerns' + '; ';} if (item49626582.r == 'Y') {descs+='Cardiac History' + '; ';} if (item35200400.r == 'Y') {descs+='Diabetes Mellitus' + '; ';} if (item15402985.r == 'Y') {descs+='Hypertension' + '; ';} if (item80087810.r == 'Y') {descs+='Medically stable' + '; ';} if (item72394837.r == 'Y') {descs+='Problems with mobility' + '; ';} if (item46214380.r == 'Y') {descs+='Communication issues' + '; ';} if (item68588107.r == 'Y') {descs+='Developmental / Psychological Disorder' + '; ';} if (item96864328.r == 'Y') {descs+='Violent Behaviour' + '; ';} if (item24665256.r == 'Y') {descs+='Seizure Disorder' + '; ';} if (item2388556.r == 'Y') {descs+='Neuromuscular Disorder' + '; ';} return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='item72495479').answer.exists(value = 'Y'),'Snoring' + '; ') | iif(%resource.repeat(item).where(linkId='item83826274').answer.exists(value = 'Y'),'Snoring with apnea' + '; ') | iif(%resource.repeat(item).where(linkId='item3849613').answer.exists(value = 'Y'),'Obesity' + '; ') | iif(%resource.repeat(item).where(linkId='item97391358').answer.exists(value = 'Y'),'Unrefreshing sleep' + '; ') | iif(%resource.repeat(item).where(linkId='item49869991').answer.exists(value = 'Y'),'Excessive Daytime sleepiness' + '; ') | iif(%resource.repeat(item).where(linkId='item74170896').answer.exists(value = 'Y'),'Frequent awakenings' + '; ') | iif(%resource.repeat(item).where(linkId='item9633588').answer.exists(value = 'Y'),'Difficulty initiating or maintaining sleep' + '; ') | iif(%resource.repeat(item).where(linkId='item92573517').answer.exists(value = 'Y'),'Restless legs' + '; ') | iif(%resource.repeat(item).where(linkId='item55426052').answer.exists(value = 'Y'),'Unusual movement during sleep' + '; ') | iif(%resource.repeat(item).where(linkId='item22456535').answer.exists(value = 'Y'),'Abnormal behaviour during sleep' + '; ') | iif(%resource.repeat(item).where(linkId='item65409751').answer.exists(value = 'Y'),'Oxygen concerns' + '; ') | iif(%resource.repeat(item).where(linkId='item49626582').answer.exists(value = 'Y'),'Cardiac History' + '; ') | iif(%resource.repeat(item).where(linkId='item35200400').answer.exists(value = 'Y'),'Diabetes Mellitus' + '; ') | iif(%resource.repeat(item).where(linkId='item15402985').answer.exists(value = 'Y'),'Hypertension' + '; ') | iif(%resource.repeat(item).where(linkId='item80087810').answer.exists(value = 'Y'),'Medically stable' + '; ') | iif(%resource.repeat(item).where(linkId='item72394837').answer.exists(value = 'Y'),'Problems with mobility' + '; ') | iif(%resource.repeat(item).where(linkId='item46214380').answer.exists(value = 'Y'),'Communication issues' + '; ') | iif(%resource.repeat(item).where(linkId='item68588107').answer.exists(value = 'Y'),'Developmental / Psychological Disorder' + '; ') | iif(%resource.repeat(item).where(linkId='item96864328').answer.exists(value = 'Y'),'Violent Behaviour' + '; ') | iif(%resource.repeat(item).where(linkId='item24665256').answer.exists(value = 'Y'),'Seizure Disorder' + '; ') | iif(%resource.repeat(item).where(linkId='item2388556').answer.exists(value = 'Y'),'Neuromuscular Disorder' + '; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <linkId value="ax_bodySite" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (item92573517.r == 'Y') {descs+='Leg(s)' + '; ';} if (item49626582.r == 'Y' || item15402985.r == 'Y') {descs+='Heart' + '; ';} if (item35200400.r == 'Y') {descs+='Pancreas' + '; ';} if (item2388556.r == 'Y') {descs+='Nervous System' + '; ';} return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='item92573517').answer.exists(value = 'Y'),'Leg(s)' + '; ') | iif(%resource.repeat(item).where(linkId='item49626582').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item15402985').answer.exists(value = 'Y'),'Heart' + '; ') | iif(%resource.repeat(item).where(linkId='item35200400').answer.exists(value = 'Y'),'Pancreas' + '; ') | iif(%resource.repeat(item).where(linkId='item2388556').answer.exists(value = 'Y'),'Nervous System' + '; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <linkId value="ax_v_bp" /> <text value="Sleep Disorder Clinic eReferral Form [FINAL JULY 2024]; 2024.07.25" /> <type value="display" /> </item> </item> </item> </Questionnaire>


  
    
      
      
    
  
  
    
  
  
    
      
        
        
      
    
    
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
    
  
  
  
  
  <status value="active" />
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          <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression">
            <valueExpression>
              <language value="text/fhirpath" />
              <expression value="%`var-ptPmoc`" />
            </valueExpression>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" />
                <code value="push-button" />
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
            <extension url="text">
              <valueString value="Best Method of Contact:" />
            </extension>
          </extension>
          <linkId value="BestContactMethod" />
          <text value="Best Method of Contact:" />
          <type value="choice" />
          <repeats value="false" />
          <answerOption>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="1" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" />
              <code value="OTHER" />
              <display value="OTHER" />
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="1" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" />
              <code value="HOME" />
              <display value="HOME" />
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="1" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" />
              <code value="BUSINESS" />
              <display value="BUSINESS" />
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="0" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_BestContactMethod" />
              <code value="EMAIL" />
              <display value="EMAIL" />
            </valueCoding>
          </answerOption>
        </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="BestContactMethod.r.includes('OTHER') || BestContactMethod.r.includes('HOME') || BestContactMethod.r.includes('BUSINESS')== true" />
                <language value="text/fhirpath" />
                <expression value="%resource.repeat(item).where(linkId='BestContactMethod').answer.value.contains('OTHER')  or  %resource.repeat(item).where(linkId='BestContactMethod').answer.value.contains('HOME')  or  %resource.repeat(item).where(linkId='BestContactMethod').answer.value.contains('BUSINESS')= true" />
              </valueExpression>
            </extension>
            <extension url="text">
              <valueString value="Voicemail acceptable: No" />
            </extension>
            <extension url="positiveText">
              <valueString value="Voicemail acceptable: Yes" />
            </extension>
          </extension>
          <linkId value="item73068595" />
          <text value="Voicemails acceptable" />
          <type value="boolean" />
          <enableWhen>
            <question value="BestContactMethod" />
            <operator value="=" />
            <answerCoding>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item73068595" />
              <code value="OTHER" />
              <display value="OTHER" />
            </answerCoding>
          </enableWhen>
          <enableWhen>
            <question value="BestContactMethod" />
            <operator value="=" />
            <answerCoding>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item73068595" />
              <code value="HOME" />
              <display value="HOME" />
            </answerCoding>
          </enableWhen>
          <enableWhen>
            <question value="BestContactMethod" />
            <operator value="=" />
            <answerCoding>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item73068595" />
              <code value="BUSINESS" />
              <display value="BUSINESS" />
            </answerCoding>
          </enableWhen>
          <enableBehavior value="all" />
        </item>
        <item>
          <linkId value="item95810306" />
          <text value="Where appropriate, please provide:" />
          <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="Appointment booking contact" />
            </extension>
            <extension url="style">
              <valueString value="text-decoration:underline;" />
            </extension>
          </extension>
          <linkId value="AlternateContact" />
          <text value="Appointment booking contact (if not patient)" />
          <type value="boolean" />
        </item>
        <item>
          <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression">
            <valueExpression>
              <language value="text/fhirpath" />
              <expression value="%`var-ptEmergencyContact`" />
            </valueExpression>
          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
            <extension url="text">
              <valueString value="Name:" />
            </extension>
          </extension>
          <linkId value="item6554535" />
          <text value="Contact Name:" />
          <type value="string" />
          <enableWhen>
            <question value="AlternateContact" />
            <operator value="=" />
            <answerBoolean value="true" />
          </enableWhen>
          <enableBehavior value="all" />
          <required value="true" />
        </item>
        <item>
          <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression">
            <valueExpression>
              <language value="text/fhirpath" />
              <expression value="%`var-ptEmergencyContactPhone`" />
            </valueExpression>
          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
            <extension url="text">
              <valueString value="Phone Number:" />
            </extension>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
            <extension url="key">
              <valueId value="item80027355" />
            </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="item80027355" />
          <text value="Phone Number (if different than patient):" />
          <type value="string" />
          <enableWhen>
            <question value="AlternateContact" />
            <operator value="=" />
            <answerBoolean value="true" />
          </enableWhen>
          <enableBehavior value="all" />
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control" />
                <code value="check-box" />
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
            <extension url="enableWhenExpression">
              <valueExpression>
                <description value="false" />
                <language value="text/fhirpath" />
                <expression value="false" />
              </valueExpression>
            </extension>
            <extension url="text">
              <valueString value="Special Considerations:" />
            </extension>
          </extension>
          <linkId value="SpecialConsiderations" />
          <text value="Special considerations (3rd party insurance, accessibility, barriers, tips for care delivery)" />
          <type value="boolean" />
        </item>
        <item>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
            <extension url="text">
              <valueString value="Special Considerations: {{answer}}" />
            </extension>
          </extension>
          <linkId value="item38347402" />
          <text value="Details of special considerations:" />
          <type value="text" />
          <enableWhen>
            <question value="SpecialConsiderations" />
            <operator value="=" />
            <answerBoolean value="true" />
          </enableWhen>
          <enableBehavior value="all" />
          <required value="true" />
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
            <valueBoolean value="true" />
          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
            <extension url="text">
              <valueString value="#blank_line#" />
            </extension>
          </extension>
          <linkId value="item25397237" />
          <type value="display" />
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
          <extension url="key">
            <valueId value="item10476570" />
          </extension>
          <extension url="severity">
            <valueCode value="error" />
          </extension>
          <extension url="human">
            <valueString value="Please obey rules specified in instructions" />
          </extension>
          <extension url="expression">
            <valueExpression>
              <description value="ScriptUtil.percentComplete( PreferredLoc) != 0" />
              <language value="text/fhirpath" />
              <expression value="%resource.repeat(item).where(linkId='PreferredLoc').select(item.where(linkId='item10476570').exists(answer) | item.where(linkId='section95718570').exists(answer) | item.where(linkId='item74312441').exists(answer)).count() * 100 / 3 != 0" />
            </valueExpression>
          </extension>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
          <extension url="text">
            <valueString value="Preferred Location(s)" />
          </extension>
          <extension url="style">
            <valueString value="font-weight:bold;text-decoration:underline;" />
          </extension>
          <extension url="listSeparator">
            <valueString>
              <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="<br/>" />
              </extension>
            </valueString>
          </extension>
        </extension>
        <linkId value="PreferredLoc" />
        <text value="Preferred Location(s) *" />
        <type value="group" />
        <item>
          <linkId value="item10476570" />
          <text value="Select all that apply:">
            <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="<i>Select all that apply</i>:" />
            </extension>
          </text>
          <type value="display" />
        </item>
        <item>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
            <extension url="listSeparator">
              <valueString>
                <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="<br/>" />
                </extension>
              </valueString>
            </extension>
          </extension>
          <linkId value="section95718570" />
          <type value="group" />
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control" />
                  <code value="check-box" />
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="item7852115" />
            <text value="Hamilton" />
            <type value="boolean" />
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="background-color:grey;" />
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            <linkId value="section31627363" />
            <type value="group" />
            <enableWhen>
              <question value="item7852115" />
              <operator value="=" />
              <answerBoolean value="true" />
            </enableWhen>
            <enableBehavior value="all" />
            <item>
              <linkId value="item42030680" />
              <text value="Telephone: 905 529 2259 Fax: 905 529 2262">
                <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="<b>Telephone:</b> 905 529 2259<br/><b>Fax:</b> 905 529 2262" />
                </extension>
              </text>
              <type value="display" />
            </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>
            <linkId value="item59448874" />
            <text value="St. Catharines" />
            <type value="boolean" />
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="background-color:grey;" />
            </extension>
            <linkId value="section55723098" />
            <type value="group" />
            <enableWhen>
              <question value="item59448874" />
              <operator value="=" />
              <answerBoolean value="true" />
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            <enableBehavior value="all" />
            <item>
              <linkId value="item90358461" />
              <text value="Telephone: 905 529 2259 Fax: 905 529 2262">
                <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="<b>Telephone:</b> 905 529 2259<br/><b>Fax:</b> 905 529 2262" />
                </extension>
              </text>
              <type value="display" />
            </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>
            <linkId value="item44065286" />
            <text value="Cambridge Memorial Hospital" />
            <type value="boolean" />
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="background-color:grey;" />
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            <linkId value="section18070968" />
            <type value="group" />
            <enableWhen>
              <question value="item44065286" />
              <operator value="=" />
              <answerBoolean value="true" />
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            <enableBehavior value="all" />
            <item>
              <linkId value="item8918930" />
              <text value="Telephone: 905 529 2259 Fax: 905 529 2262">
                <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="<b>Telephone:</b> 905 529 2259<br/><b>Fax:</b> 905 529 2262" />
                </extension>
              </text>
              <type value="display" />
            </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="item74312441" />
          <type value="display" />
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
          <extension url="key">
            <valueId value="item3508830" />
          </extension>
          <extension url="severity">
            <valueCode value="error" />
          </extension>
          <extension url="human">
            <valueString value="Please obey rules specified in instructions" />
          </extension>
          <extension url="expression">
            <valueExpression>
              <description value="ScriptUtil.percentComplete( section9816307) != 0" />
              <language value="text/fhirpath" />
              <expression value="%resource.repeat(item).where(linkId='section9816307').select(item.where(linkId='item53780705').exists(answer) | item.where(linkId='section68958263').exists(answer) | item.where(linkId='item3508830').exists(answer)).count() * 100 / 3 != 0" />
            </valueExpression>
          </extension>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
          <extension url="text">
            <valueString value="Service Request(s)" />
          </extension>
          <extension url="style">
            <valueString value="font-weight:bold;text-decoration:underline;" />
          </extension>
          <extension url="listSeparator">
            <valueString>
              <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="<br/>" />
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        <linkId value="section9816307" />
        <text value="Service Request(s) *" />
        <type value="group" />
        <item>
          <linkId value="item3508830" />
          <text value="Select all that apply:">
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              <valueString value="<i>Select all that apply</i>:" />
            </extension>
          </text>
          <type value="display" />
        </item>
        <item>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
            <extension url="listSeparator">
              <valueString>
                <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="<br/>" />
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            </extension>
          </extension>
          <linkId value="section68958263" />
          <type value="group" />
          <item>
            <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression">
              <valueExpression>
                <description value="item45390734.r==''" />
                <language value="text/fhirpath" />
                <expression value="%resource.repeat(item).where(linkId='item45390734').answer.empty()" />
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            </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="• Sleep study; consult; treatment if required" />
              </extension>
            </extension>
            <linkId value="item84731201" />
            <text value="Sleep study; consult; treatment if required" />
            <type value="boolean" />
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          <item>
            <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression">
              <valueExpression>
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                <expression value="%resource.repeat(item).where(linkId='item84731201').answer.empty()" />
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            <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="• Diagnostic sleep study only, no consult, no treatment" />
              </extension>
            </extension>
            <linkId value="item45390734" />
            <text value="Diagnostic sleep study only, no consult, no treatment" />
            <type value="boolean" />
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          <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="• Consult; followed by diagnosis and treatment if required" />
              </extension>
            </extension>
            <linkId value="item46379923" />
            <text value="Consult; followed by diagnosis and treatment if required" />
            <type value="boolean" />
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        </item>
        <item>
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            <valueBoolean value="true" />
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          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
            <extension url="text">
              <valueString value="#blank_line#" />
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          </extension>
          <linkId value="item53780705" />
          <type value="display" />
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      <item>
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          <valueString value="background-color:white;border-style:solid;" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
          <extension url="text">
            <valueString value="Reason for Referral" />
          </extension>
          <extension url="style">
            <valueString value="font-weight:bold;text-decoration:underline;" />
          </extension>
          <extension url="listSeparator">
            <valueString>
              <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="<br/>" />
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            </valueString>
          </extension>
        </extension>
        <linkId value="reasonforreferralsec" />
        <text value="Reason for Referral" />
        <type value="group" />
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" />
                <code value="push-button" />
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
            <extension url="text">
              <valueString value="Urgency:" />
            </extension>
          </extension>
          <linkId value="Urgency" />
          <text value="Urgency:" />
          <type value="choice" />
          <required value="true" />
          <repeats value="false" />
          <answerOption>
            <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
              <extension url="style">
                <valueString value="font-weight:bold;color:#008800;" />
              </extension>
            </extension>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="1" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Urgency" />
              <code value="Routine" />
              <display value="Routine" />
            </valueCoding>
            <initialSelected value="true" />
          </answerOption>
          <answerOption>
            <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
              <extension url="style">
                <valueString value="font-weight:bold;color:#EE6B00;" />
              </extension>
            </extension>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="3" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Urgency" />
              <code value="High Priority" />
              <display value="High Priority" />
            </valueCoding>
          </answerOption>
          <answerOption>
            <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
              <extension url="style">
                <valueString value="font-weight:bold;color:#AA0000;" />
              </extension>
            </extension>
            <valueCoding>
              <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                <valueDecimal value="2" />
              </extension>
              <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_Urgency" />
              <code value="Urgent" />
              <display value="Urgent" />
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <linkId value="item40810108" />
          <text value="Rationale for Urgent Referral:" />
          <type value="string" />
          <enableWhen>
            <question value="Urgency" />
            <operator value="=" />
            <answerCoding>
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              <code value="Urgent" />
              <display value="Urgent" />
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          </enableWhen>
          <enableBehavior value="all" />
          <required value="true" />
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        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
            <extension url="key">
              <valueId value="item54277157" />
            </extension>
            <extension url="severity">
              <valueCode value="error" />
            </extension>
            <extension url="human">
              <valueString value="Please obey rules specified in instructions" />
            </extension>
            <extension url="expression">
              <valueExpression>
                <description value="ScriptUtil.percentComplete( section75710709 ) != 0" />
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          </extension>
          <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
            <extension url="text">
              <valueString value="Symptom(s) Leading to Referral" />
            </extension>
            <extension url="style">
              <valueString value="font-weight:bold;" />
            </extension>
            <extension url="listSeparator">
              <valueString>
                <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="<br/>" />
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          <text value="Symptom(s) Leading to Referral *" />
          <type value="group" />
          <item>
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            <text value="Select all that apply:">
              <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="font-style:italic;" />
              </extension>
            </text>
            <type value="display" />
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          <item>
            <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
              <extension url="style">
                <valueString value="font-weight:bold;text-decoration:underline;" />
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              <extension url="listSeparator">
                <valueString>
                  <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                    <valueString value="<br/>" />
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            <linkId value="reason_for_referral" />
            <type value="group" />
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control" />
                    <code value="check-box" />
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              <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
                <extension url="sortIndex">
                  <valuePositiveInt value="11" />
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              <linkId value="item72495479" />
              <text value="Snoring" />
              <type value="boolean" />
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            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
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                    <system value="http://hl7.org/fhir/questionnaire-item-control" />
                    <code value="check-box" />
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              <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
                <extension url="sortIndex">
                  <valuePositiveInt value="12" />
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              <linkId value="item83826274" />
              <text value="Snoring with apnea" />
              <type value="boolean" />
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            <item>
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                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control" />
                    <code value="check-box" />
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              <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
                <extension url="sortIndex">
                  <valuePositiveInt value="13" />
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              <linkId value="item3849613" />
              <text value="Obesity" />
              <type value="boolean" />
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            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="background-color:grey;" />
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              <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
                <extension url="text">
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                <extension url="style">
                  <valueString value="text-decoration:underline;" />
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                <extension url="listSeparator">
                  <valueString>
                    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                      <valueString value="<br/>" />
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                <extension url="sortIndex">
                  <valuePositiveInt value="24" />
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              <type value="group" />
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                <question value="item3849613" />
                <operator value="=" />
                <answerBoolean value="true" />
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                  <valueCodeableConcept>
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                      <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" />
                      <code value="push-button" />
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                      <language value="text/fhirpath" />
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                      <code value="push-button" />
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                <text value="Feet:" />
                <type value="choice" />
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                    <display value="ft" />
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                <answerOption>
                  <valueCoding>
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                  <valueCoding>
                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="3" />
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                    <display value="3'" />
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                <answerOption>
                  <valueCoding>
                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="4" />
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                    <display value="4'" />
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                <answerOption>
                  <valueCoding>
                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="5" />
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                    <display value="5'" />
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                <answerOption>
                  <valueCoding>
                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="6" />
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                    <display value="6'" />
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                <answerOption>
                  <valueCoding>
                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="7" />
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                    <code value="7'" />
                    <display value="7'" />
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              </item>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" />
                      <code value="push-button" />
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                <linkId value="htInches" />
                <text value="Inches:" />
                <type value="choice" />
                <enableWhen>
                  <question value="item86156137" />
                  <operator value="=" />
                  <answerCoding>
                    <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_htInches" />
                    <code value="ft" />
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                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
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                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
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                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="11" />
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                    <code value="11"" />
                    <display value="11"" />
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                  <valueExpression>
                    <language value="text/fhirpath" />
                    <expression value="%`var-ptLatestVal.ht`" />
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                <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
                  <extension url="text">
                    <valueString value="Height: {{answer}} cm" />
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                <linkId value="htCm" />
                <text value="Height (cm):" />
                <type value="decimal" />
                <enableWhen>
                  <question value="item86156137" />
                  <operator value="=" />
                  <answerCoding>
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                    <code value="cm" />
                    <display value="cm" />
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                <enableBehavior value="any" />
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                      <code value="push-button" />
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                      <expression value="false" />
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                <type value="choice" />
                <repeats value="false" />
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                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="1" />
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                    <code value="kg" />
                    <display value="kg" />
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                <answerOption>
                  <valueCoding>
                    <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight">
                      <valueDecimal value="2" />
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                    <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_item41557024" />
                    <code value="lb" />
                    <display value="lb" />
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              <item>
                <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression">
                  <valueExpression>
                    <language value="text/fhirpath" />
                    <expression value="%`var-ptLatestVal.wt`" />
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                <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
                  <extension url="text">
                    <valueString value="Weight: {{answer}} kg" />
                  </extension>
                </extension>
                <linkId value="wtKgs" />
                <text value="Weight (kg):" />
                <type value="decimal" />
                <enableWhen>
                  <question value="item41557024" />
                  <operator value="=" />
                  <answerCoding>
                    <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_wtKgs" />
                    <code value="kg" />
                    <display value="kg" />
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                <enableBehavior value="any" />
              </item>
              <item>
                <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
                  <extension url="text">
                    <valueString value="Weight: {{answer}} lb" />
                  </extension>
                </extension>
                <linkId value="wtLbs" />
                <text value="Weight (lb):" />
                <type value="decimal" />
                <enableWhen>
                  <question value="item41557024" />
                  <operator value="=" />
                  <answerCoding>
                    <system value="http://ontariohealth.ca/legacy/CodeSystem/sleep-disorder-clini_wtLbs" />
                    <code value="lb" />
                    <display value="lb" />
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                </enableWhen>
                <enableBehavior value="any" />
              </item>
              <item>
                <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression">
                  <valueExpression>
                    <description value="(htCm.p!='' || (htFeet.p!='' && htInches.p!='')) && (wtLbs.p!='' || wtKgs.p!='')" />
                    <language value="text/fhirpath" />
                    <expression value="(%resource.repeat(item).where(linkId='htCm').answer.exists()  or  (%resource.repeat(item).where(linkId='htFeet').answer.value.weight()!=''  and  %resource.repeat(item).where(linkId='htInches').answer.value.weight()!=''))  and  (%resource.repeat(item).where(linkId='wtLbs').answer.exists()  or  %resource.repeat(item).where(linkId='wtKgs').answer.exists())" />
                  </valueExpression>
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                <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
                  <extension url="enableWhenExpression">
                    <valueExpression>
                      <description value="item41557024.p!='' && item86156137.p!=''" />
                      <language value="text/fhirpath" />
                      <expression value="%resource.repeat(item).where(linkId='item41557024').answer.value.weight()!=''  and  %resource.repeat(item).where(linkId='item86156137').answer.value.weight()!=''" />
                    </valueExpression>
                  </extension>
                </extension>
                <linkId value="item45612156" />
                <text>
                  <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
                    <valueExpression>
                      <description value="(function() {   var ht = 0;   var wt = 0;   var BMI = 0;    if (htCm.p != 0) {     ht = htCm.p / 100;   } else if (htFeet.p != 0 && htInches.p != '') {     ht = (0.3048*htFeet.p) + (0.0254*htInches.p);   }    if (wtLbs.p && wtLbs.p != 0) {     wt = wtLbs.p * 0.453592;   } else {     wt = wtKgs.p;   }    BMI = wt / (ht * ht);    return Math.round(BMI*10/10); })();" />
                      <language value="text/fhirpath" />
                      <expression value="iif(
  %resource.item.where(linkId = 'htCm').answer.valueDecimal != 0,
  %resource.item.where(linkId = 'htCm').answer.valueDecimal / 100,
  iif(
    %resource.item.where(linkId = 'htFeet').answer.valueDecimal != 0
      and %resource.item.where(linkId = 'htInches').answer.valueDecimal != '',
    (0.3048 * %resource.item.where(linkId = 'htFeet').answer.valueDecimal)
      + (0.0254 * %resource.item.where(linkId = 'htInches').answer.valueDecimal),
    0
  )
).select(
  $this.power(-1).select(
    iif(
      %resource.item.where(linkId = 'wtLbs').answer.valueDecimal.exists()
        and %resource.item.where(linkId = 'wtLbs').answer.valueDecimal != 0,
      %resource.item.where(linkId = 'wtLbs').answer.valueDecimal * 0.453592,
      %resource.item.where(linkId = 'wtKgs').answer.valueDecimal
    ) * $this * $this
  )
).round(0)" />
                    </valueExpression>
                  </extension>
                </text>
                <type value="display" />
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control" />
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        <text value="Sleep Disorder Clinic eReferral Form [FINAL JULY 2024]; 2024.07.25" />
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