{% capture childItems %}{% if QuestionnaireResponse.item.where(linkId = 'patient_header').exists() %}Patient Information
{% for currentItem in QuestionnaireResponse.item.where(linkId = 'patient_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'patient_surname' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_surname' and answer.exists()) %}{% if currentItem.answer.exists() %}Surname: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_firstname' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_firstname' and answer.exists()) %}{% if currentItem.answer.exists() %}First Name: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_date_of_birth' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_date_of_birth' and answer.exists()) %}{% if currentItem.answer.exists() %}DOB: {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_gender' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_gender' and answer.exists()) %}{% if currentItem.answer.exists() %}Gender: {% for answer in currentItem.answer %}{% if answer.value.code = 'male' %}Male{% endif %}{% if answer.value.code = 'female' %}Female{% endif %}{% if answer.value.code = 'other' %}Other{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_hc_pc' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_hc_pc' and answer.exists()) %}{% if currentItem.answer.exists() %}HN PC: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_hc_number' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_hc_number' and answer.exists()) %}{% if currentItem.answer.exists() %}HN: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_hc_vc' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_hc_vc' and answer.exists()) %}{% if currentItem.answer.exists() %}HN VC: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_line1' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_line1' and answer.exists()) %}{% if currentItem.answer.exists() %}Address (Line 1): {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_line2' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_line2' and answer.exists()) %}{% if currentItem.answer.exists() %}Address (Line 2): {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_city' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_city' and answer.exists()) %}{% if currentItem.answer.exists() %}City: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_province' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_province' and answer.exists()) %}{% if currentItem.answer.exists() %}Province: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_address_postalcode' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_address_postalcode' and answer.exists()) %}{% if currentItem.answer.exists() %}Postal Code: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_phone_mobile' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_phone_mobile' and answer.exists()) %}{% if currentItem.answer.exists() %}Mobile #: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_phone_home' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_phone_home' and answer.exists()) %}{% if currentItem.answer.exists() %}Home #: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_phone_business' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_phone_business' and answer.exists()) %}{% if currentItem.answer.exists() %}Business #: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'patient_email' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'patient_email' and answer.exists()) %}{% if currentItem.answer.exists() %}Email: {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if QuestionnaireResponse.item.where(linkId = 'additionalinfo_header').exists() %}[Optional] Additional Patient Information
{% for currentItem in QuestionnaireResponse.item.where(linkId = 'additionalinfo_header') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredname' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredname' and answer.exists()) %}{% if currentItem.answer.exists() %}Preferred Name
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_sexassignedatbirth' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_sexassignedatbirth' and answer.exists()) %}{% if currentItem.answer.exists() %}Sex assigned at birth:
{% for answer in currentItem.answer %}{% if answer.value = 'Female' %}Female{% endif %}{% if answer.value = 'Male' %}Male{% endif %}{% if answer.value = 'Intersex' %}Intersex{% endif %}{% if answer.value = 'Unknown' %}Unknown{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_pronouns' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_pronouns' and answer.exists()) %}{% if currentItem.answer.exists() %}Pronouns:
{% for answer in currentItem.answer %}{% if answer.value.code = '21317' %}She/Her{% endif %}{% if answer.value.code = '21318' %}He/Him{% endif %}{% if answer.value.code = '21319' %}They/Them{% endif %}{% if answer.value.code = 'OTH' %}Other{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_pronouns_other' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_pronouns_other' and answer.exists()) %}{% if currentItem.answer.exists() %}Other pronouns:
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage' and answer.exists()) %}{% if currentItem.answer.exists() %}Preferred language {% for answer in currentItem.answer %}{% if answer.value.code = 'en' %}English{% endif %}{% if answer.value.code = 'fr' %}French{% endif %}{% if answer.value.code = 'OTH' %}Other{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_section').exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_section') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_specify' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_specify' and answer.exists()) %}{% if currentItem.answer.exists() %}Specify language and considerations:
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_interpreterrequired' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_preferredlanguage_interpreterrequired' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Interpreter Required' %}Interpreter Required{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact' and answer.exists()) %}{% if currentItem.answer.exists() %}Best method of contact: {% for answer in currentItem.answer %}{% if answer.value.code = 'mobile' %}Mobile{% endif %}{% if answer.value.code = 'home' %}Home{% endif %}{% if answer.value.code = 'work' %}Work{% endif %}{% if answer.value.code = 'email' %}Email{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact_voicemails' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact_voicemails' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Voicemails acceptable' %}Voicemails acceptable{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact_prefersms' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_bestmethodofcontact_prefersms' and answer.exists()) %}{% if currentItem.answer.exists() %}Patient prefers SMS/text if available {% for answer in currentItem.answer %}{% if answer.value = 'Prefer SMS/Text if available' %}Prefer SMS/Text if available{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Identify parent/guardian, care contact, or Substitute Decision Maker' %}Identify parent/guardian, care contact, or Substitute Decision Maker{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_section').exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_section') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_name' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_name' and answer.exists()) %}{% if currentItem.answer.exists() %}First Contact name:
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_phone' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_phone' and answer.exists()) %}{% if currentItem.answer.exists() %}Phone (if different than pt):
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_email' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_email' and answer.exists()) %}{% if currentItem.answer.exists() %}Email (if different than pt):
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_relation' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_relation' and answer.exists()) %}{% if currentItem.answer.exists() %}Relationship (incl. SDM):
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_apptbookcontact' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_firstcontact_apptbookcontact' and answer.exists()) %}{% if currentItem.answer.exists() %}Is this person an appointment booking contact?
{% for answer in currentItem.answer %}{% if answer.value = 'Yes' %}Yes{% endif %}{% if answer.value = 'No' %}No{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_name' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_name' and answer.exists()) %}{% if currentItem.answer.exists() %}Second Contact name:
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_phone' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_phone' and answer.exists()) %}{% if currentItem.answer.exists() %}Phone (if different than pt):
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_email' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_email' and answer.exists()) %}{% if currentItem.answer.exists() %}Email (if different than pt):
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_relation' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_relation' and answer.exists()) %}{% if currentItem.answer.exists() %}Relationship (incl. SDM):
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_apptbookcontact' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_parentguardianSDM_secondcontact_apptbookcontact' and answer.exists()) %}{% if currentItem.answer.exists() %}Is this person an appointment booking contact?
{% for answer in currentItem.answer %}{% if answer.value = 'Yes' %}Yes{% endif %}{% if answer.value = 'No' %}No{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontactsprivacy_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontactsprivacy_select' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Do not contact (e.g. safety, privacy)' %}Do not contact (e.g. safety, privacy){% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontactsprivacy_section').exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontactsprivacy_section') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_speakwithpatientdirectly' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_speakwithpatientdirectly' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Only contact patient directly' %}Only contact patient directly{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_donotspeakwith' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_unsafecontacts_donotspeakwith' and answer.exists()) %}{% if currentItem.answer.exists() %}Do not speak with:
{% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_select' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Accessibility concerns or disability' %}Accessibility concerns or disability{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_section').exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_section') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value.code = '21269' %}Cognitively impaired{% endif %}{% if answer.value.code = '21270' %}Falls risk{% endif %}{% if answer.value.code = '21271' %}Hearing impaired{% endif %}{% if answer.value.code = '21272' %}Patient requires lift{% endif %}{% if answer.value.code = '21273' %}Vision impaired{% endif %}{% if answer.value.code = '21274' %}Wheelchair{% endif %}{% if answer.value.code = 'OTH' %}Other{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_specify' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_accessibilityconcernsordisability_specify' and answer.exists()) %}{% if currentItem.answer.exists() %}Specify {% for answer in currentItem.answer %}{{ answer.value.extension('').extension('').value.ofType(string) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'additionalinfo_specialconsiderations_select' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'additionalinfo_specialconsiderations_select' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for currentItem in QuestionnaireResponse.item.where(linkId = 'medicalImaging_patientsafety_group') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_section').exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_section') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_restingHR' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_restingHR' and answer.exists()) %}{% if currentItem.answer.exists() %}What is the patient's current resting heart rate (bpm)? {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_known_contraindications_Nitro' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_known_contraindications_Nitro' and answer.exists()) %}{% if currentItem.answer.exists() %}Known contraindications to Nitroglycerin: (e.g., allergy, on PDE inhibitor such as Viagra® or Cialis®) {% for answer in currentItem.answer %}{% if answer.value = 'No' %}No{% endif %}{% if answer.value = 'Yes' %}Yes{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_on_betaBlockers' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_on_betaBlockers' and answer.exists()) %}{% if currentItem.answer.exists() %}Is the patient currently on beta-blockers? {% for answer in currentItem.answer %}{% if answer.value = 'No' %}No{% endif %}{% if answer.value = 'Yes' %}Yes{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_betaBlocker_concerns' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_betaBlocker_concerns' and answer.exists()) %}{% if currentItem.answer.exists() %}Concerns for beta-blockers use: {% for answer in currentItem.answer %}{% if answer.value = 'Severe/critical aortic stenosis' %}Severe/critical aortic stenosis{% endif %}{% if answer.value = 'Severe symptomatic aortic insufficiency' %}Severe symptomatic aortic insufficiency{% endif %}{% if answer.value = 'Decompensated congestive heart failure' %}Decompensated congestive heart failure{% endif %}{% if answer.value = 'Allergy to Beta-blockers' %}Allergy to Beta-blockers{% endif %}{% if answer.value = 'Prior hospitalization for lung disease' %}Prior hospitalization for lung disease{% endif %}{% if answer.value = 'Active bronchospasm' %}Active bronchospasm{% endif %}{% if answer.value = '2nd or 3rd degree heart block, or 1st degree with PR>0.42s' %}2nd or 3rd degree heart block, or 1st degree with PR>0.42s{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %}and{% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_betaBlockerRx' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_cardiac_betaBlockerRx' and answer.exists()) %}{% if currentItem.answer.exists() %}Will the patient be prescribed a beta-blocker? {% for answer in currentItem.answer %}{% if answer.value = 'No' %}No{% endif %}{% if answer.value = 'Yes' %}Yes{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_renal' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_renal' and answer.exists()) %}{% if currentItem.answer.exists() %}Renal Assessment Questions: {% for answer in currentItem.answer %}{% if answer.value.code = '21283' %}No known kidney issues{% endif %}{% if answer.value.code = '21316' %}Patient has impaired renal function or a history of renal transplant{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_recentegfr').exists() %}Recent (within 6 months) estimated Glomerular Filtration Rate (eGFR):
{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_recentegfr') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_eGFR_result' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_eGFR_result' and answer.exists()) %}{% if currentItem.answer.exists() %}eGFR result: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_eGFR_date' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_eGFR_date' and answer.exists()) %}{% if currentItem.answer.exists() %}eGFR date: {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_hasDiabetes' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_hasDiabetes' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value.code = '21286' %}Has diabetes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_dialysis').exists() %}On dialysis:
{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_dialysis') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_onDialysis' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_onDialysis' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value.code = '21287' %}On dialysis{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_contrastguidance').exists() %}Guidance on Contrast
{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_contrastguidance') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_contrastguidance_question' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_contrastguidance_question' and answer.exists()) %}{% if currentItem.answer.exists() %}Guidance on Contrast Associated Acute Kidney Injury {% for answer in currentItem.answer %}{% if answer.value = 'Hide' %}Hide{% endif %}{% if answer.value = 'Show' %}Show{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_knownhypersensitivity' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_knownhypersensitivity' and answer.exists()) %}{% if currentItem.answer.exists() %}Known hypersensitivity to contrast agents: {% for answer in currentItem.answer %}{% if answer.value = 'Yes' %}Yes{% endif %}{% if answer.value = 'No' %}No{% endif %}{% if answer.value = 'Unknown' %}Unknown{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_currentlypregnant' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_currentlypregnant' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value.code = '21261' %}Currently Pregnant{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_currentlypregnant_sub').exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_currentlypregnant_sub') %}{% capture childItems %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_estimateddelivery' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_estimateddelivery' and answer.exists()) %}{% if currentItem.answer.exists() %}Estimated Date of Delivery: {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_lastmenstrualdate' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_lastmenstrualdate' and answer.exists()) %}{% if currentItem.answer.exists() %}Last Menstrual Period: {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% endcapture %}{% assign itemList = childItems || remove_last: '$SEP$' || split: '$SEP$' %}{% for listItem in itemList %}{{ listItem }}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_breastfeeding' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_breastfeeding' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value.code = '21293' %}Currently breastfeeding{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_reliable' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_reliable' and answer.exists()) %}{% if currentItem.answer.exists() %}
{% for answer in currentItem.answer %}{% if answer.value = 'Patient cannot provide reliable medical history or provide consent to contrast injections (where applicable)' %}Patient cannot provide reliable medical history or provide consent to contrast injections (where applicable){% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_accessibility' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_accessibility' and answer.exists()) %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{% if answer.value = 'Accessibility concerns or disability' %}Accessibility concerns or disability{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endfor %}$SEP${% endif %}{% if currentItem.item.where(linkId = 'medicalImaging_patientsafety_accessibility_specify' and answer.exists()).exists() %}{% for currentItem in currentItem.item.where(linkId = 'medicalImaging_patientsafety_accessibility_specify' and answer.exists()) %}{% if currentItem.answer.exists() %}