{
  "description": "Initial Safegaurding Contact is used by Emergency Service and Health and Care Agencies to refer safegaurding concerns to the Loacal Authority",
  "_filename": "examples/Questionnaire-example.json",
  "package_name": "supportedhospitaldischarge.stu3",
  "date": "2021-07-22T15:00:00+01:00",
  "publisher": "NottsCC",
  "purpose": "Initial Safegaurding Contact is used by Emergency Service and Health and Care Agencies to refer safegaurding concerns to the Loacal Authority",
  "name": "Questionnaire-InitialSafegaurdingContact",
  "item": [ {
    "item": [ {
      "text": "Referral Type",
      "type": "text",
      "linkId": "1.1"
    }, {
      "text": "Referring Organisation",
      "type": "text",
      "linkId": "1.2"
    }, {
      "text": "Contact Name",
      "type": "text",
      "linkId": "1.3"
    }, {
      "text": "Contact Email",
      "type": "text",
      "linkId": "1.4"
    }, {
      "text": "Contact Phone",
      "type": "text",
      "linkId": "1.5"
    }, {
      "text": "Date/Time of Referral",
      "type": "dateTime",
      "linkId": "1.6"
    }, {
      "text": "Rationale for Referral",
      "type": "text",
      "linkId": "1.7"
    }, {
      "text": "Incident Number / ID",
      "type": "text",
      "linkId": "1.8"
    }, {
      "text": "Incident Description",
      "type": "text",
      "linkId": "1.9"
    }, {
      "text": "Date / Time of Incident",
      "type": "dateTime",
      "linkId": "1.10"
    }, {
      "text": "Location of Incident",
      "type": "text",
      "linkId": "1.11"
    }, {
      "text": "Attending Persons",
      "type": "text",
      "linkId": "1.12"
    }, {
      "text": "Other Involved Agencies",
      "type": "text",
      "linkId": "1.13",
      "repeats": true
    } ],
    "text": "General",
    "type": "group",
    "linkId": "1"
  }, {
    "item": [ {
      "text": "Name",
      "type": "text",
      "linkId": "2.1"
    }, {
      "text": "NHS Number",
      "type": "text",
      "linkId": "2.2"
    }, {
      "text": "Date of Birth",
      "type": "dateTime",
      "linkId": "2.3"
    }, {
      "text": "Age at time of event",
      "type": "text",
      "linkId": "2.4"
    }, {
      "text": "Category",
      "type": "text",
      "linkId": "2.5"
    }, {
      "text": "Relationship to victim/subject",
      "type": "text",
      "linkId": "2.6"
    }, {
      "text": "Relation to other",
      "type": "text",
      "linkId": "2.7"
    }, {
      "text": "Involvement",
      "type": "text",
      "linkId": "2.8"
    }, {
      "text": "Employment",
      "type": "text",
      "linkId": "2.9"
    }, {
      "text": "Address",
      "type": "text",
      "linkId": "2.10"
    }, {
      "text": "Postcode",
      "type": "text",
      "linkId": "2.11"
    }, {
      "text": "Home Phone",
      "type": "text",
      "linkId": "2.12"
    }, {
      "text": "Mobile Phone",
      "type": "text",
      "linkId": "2.13"
    }, {
      "text": "Email",
      "type": "text",
      "linkId": "2.14"
    }, {
      "text": "SAFE Telephone Numbers (if recorded)",
      "type": "text",
      "linkId": "2.15"
    }, {
      "text": "Other contact details",
      "type": "text",
      "linkId": "2.16"
    }, {
      "text": "Preferred means of contact",
      "type": "text",
      "linkId": "2.17"
    }, {
      "text": "Ethnicity",
      "type": "text",
      "linkId": "2.18"
    }, {
      "text": "Gender",
      "type": "text",
      "linkId": "2.19"
    }, {
      "text": "Relevant aggravating factors",
      "type": "text",
      "linkId": "2.20"
    }, {
      "text": "GP name",
      "type": "text",
      "linkId": "2.21"
    }, {
      "text": "GP ODS code",
      "type": "text",
      "linkId": "2.22"
    }, {
      "text": "GP surgery",
      "type": "text",
      "linkId": "2.23"
    }, {
      "text": "GP address",
      "type": "text",
      "linkId": "2.24"
    }, {
      "text": "GP telephone",
      "type": "text",
      "linkId": "2.25"
    }, {
      "text": "School",
      "type": "text",
      "linkId": "2.26"
    }, {
      "text": "Present at time of the incident?",
      "type": "text",
      "linkId": "2.27"
    }, {
      "text": "Welfare check of children made?",
      "type": "text",
      "linkId": "2.28"
    }, {
      "text": "Any communication barriers?",
      "type": "text",
      "linkId": "2.29"
    }, {
      "text": "Interpreter required?",
      "type": "text",
      "linkId": "2.30"
    }, {
      "text": "Are there any passport/legal status issues?",
      "type": "text",
      "linkId": "2.31"
    }, {
      "text": "Any other comments?",
      "type": "text",
      "linkId": "2.32"
    } ],
    "text": "People Involved",
    "type": "group",
    "linkId": "2",
    "repeats": true
  }, {
    "item": [ {
      "text": "Question",
      "type": "text",
      "linkId": "3.1"
    }, {
      "text": "Answer",
      "type": "text",
      "linkId": "3.2"
    } ],
    "text": "Additional Information",
    "type": "group",
    "linkId": "3",
    "repeats": true
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Questionnaire-InitialSafegaurdingContact",
  "package_version": "0.1.5",
  "status": "draft",
  "id": "734e2fd5-33b2-4d56-9d6d-27fa5717fa6f",
  "kind": null,
  "url": "https://fhir.nottinghamshire.gov.uk/STU3/Questionnaire/RSC-Questionnaire-InitialSafeguardingContact",
  "version": "0.0.1"
}