{
  "description": "Sample questionnaire using all questions from the Catalyst Problem Gambling Required Data Form",
  "_filename": "Gambling-Questionnaire-Template.json",
  "package_name": "ca.on.mha.pds",
  "date": null,
  "publisher": null,
  "purpose": "To serve as a model to build required MHA Gambling questionnaires.",
  "name": null,
  "item": [ {
    "text": "Reason for Seeking Help With Gambling Behaviour",
    "type": "choice",
    "linkId": "Q1",
    "required": true,
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-help-seeking-reason"
  }, {
    "text": "Number of Months Life Negatively Affected by Gambling Behaviour",
    "type": "integer",
    "linkId": "Q2",
    "enableWhen": [ {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "1",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    }, {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "2",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    } ],
    "enableBehavior": "any"
  }, {
    "text": "Length of Time Since Last Gambling Activity (Days)",
    "type": "integer",
    "linkId": "Q3",
    "enableWhen": [ {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "1",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    }, {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "2",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    } ],
    "enableBehavior": "any"
  }, {
    "text": "Sequence of Gambling Problem Identification",
    "type": "choice",
    "linkId": "Q4",
    "enableWhen": [ {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "1",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    }, {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "2",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    } ],
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/sequence-of-gambling-problem",
    "enableBehavior": "any"
  }, {
    "item": [ {
      "text": "Primary Gambling Activity Frequency in last 12 months",
      "type": "choice",
      "linkId": "Q5-a",
      "required": true,
      "enableWhen": [ {
        "operator": "exists",
        "question": "Q5",
        "answerBoolean": true
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
    }, {
      "text": "Primary Gambling Location in last 12 months",
      "type": "choice",
      "linkId": "Q5-b",
      "required": true,
      "enableWhen": [ {
        "operator": "exists",
        "question": "Q5-a",
        "answerBoolean": true
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
    }, {
      "text": "Primary Gambling Location Frequency in last 12 months",
      "type": "choice",
      "linkId": "Q5-c",
      "required": true,
      "enableWhen": [ {
        "operator": "exists",
        "question": "Q5-b",
        "answerBoolean": true
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
    } ],
    "text": "Primary Gambling Activity in the last 12 months",
    "type": "choice",
    "linkId": "Q5",
    "enableWhen": [ {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "1",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    }, {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "2",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason"
      }
    } ],
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year",
    "enableBehavior": "any"
  }, {
    "item": [ {
      "text": "Additional Gambling Activity Frequency in last 12 months",
      "type": "choice",
      "linkId": "Q6-a",
      "required": true,
      "enableWhen": [ {
        "operator": "exists",
        "question": "Q6",
        "answerBoolean": true
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
    }, {
      "text": "Additional Gambling Location in last 12 months",
      "type": "choice",
      "linkId": "Q6-b",
      "required": true,
      "enableWhen": [ {
        "operator": "exists",
        "question": "Q6-a",
        "answerBoolean": true
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
    }, {
      "text": "Additional Gambling Location Frequency in last 12 months",
      "type": "choice",
      "linkId": "Q6-c",
      "required": true,
      "enableWhen": [ {
        "operator": "exists",
        "question": "Q6-b",
        "answerBoolean": true
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
    } ],
    "text": "Additional Gambling Activity in the last 12 months",
    "type": "choice",
    "linkId": "Q6",
    "repeats": true,
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year"
  }, {
    "item": [ {
      "text": "Percentage of Time Spent Gambling in Ontario",
      "type": "integer",
      "linkId": "Q7-a"
    }, {
      "text": "Percentage of Time Spent Gambling in another province",
      "type": "integer",
      "linkId": "Q7-b"
    }, {
      "text": "Percentage of Time Spent Gambling Outside of Canada",
      "type": "integer",
      "linkId": "Q7-c"
    } ],
    "text": "Percentage of Time Spent Gambling by Jurisdiction",
    "type": "group",
    "linkId": "Q7"
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "MHA Gambling Questionnaire Template",
  "package_version": "2.0.0-snapshot14",
  "status": "active",
  "id": "3c3b6726-da7a-436e-abe9-3aefba9e51f8",
  "kind": null,
  "url": "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-gambling-questionnaire-template",
  "version": null
}