{
  "description": "Sample questionnaire using all questions from the Catalyst Problem Gambling Required Data Form",
  "_filename": "examples/Gambling-Questionnaire-Template.json",
  "package_name": "ca.on.oh.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"
  }, {
    "item": [ {
      "text": "Number of Months Life Negatively Affected by Gambling Behaviour",
      "type": "integer",
      "linkId": "Q2"
    }, {
      "text": "Length of Time Since Last Gambling Activity (Days)",
      "type": "integer",
      "linkId": "Q3"
    }, {
      "text": "Sequence of Gambling Problem Identification",
      "type": "choice",
      "linkId": "Q4",
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/sequence-of-gambling-problem"
    }, {
      "item": [ {
        "text": "Primary Gambling Activity Frequency in last 12 months",
        "type": "choice",
        "linkId": "Q5-a",
        "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
      }, {
        "text": "Primary Gambling Location in last 12 months",
        "type": "choice",
        "linkId": "Q5-b",
        "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
      }, {
        "text": "Primary Gambling Location Frequency in last 12 months",
        "type": "choice",
        "linkId": "Q5-c",
        "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
      } ],
      "text": "Primary Gambling Activity in the last 12 months",
      "type": "choice",
      "linkId": "Q5",
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year"
    }, {
      "item": [ {
        "text": "Additional Gambling Activity Frequency in last 12 months",
        "type": "choice",
        "linkId": "Q6-a",
        "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
      }, {
        "text": "Additional Gambling Location in last 12 months",
        "type": "choice",
        "linkId": "Q6-b",
        "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
      }, {
        "text": "Addtional Gambling Location Frequency in last 12 months",
        "type": "choice",
        "linkId": "Q6-c",
        "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": "group",
    "linkId": "Q2-Q7",
    "enableWhen": [ {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "1",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason",
        "display": "Related to others gambling problem"
      }
    }, {
      "operator": "=",
      "question": "Q1",
      "answerCoding": {
        "code": "2",
        "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason",
        "display": "Both"
      }
    } ],
    "enableBehavior": "any"
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "MHA Gambling Questionnaire Template",
  "package_version": "0.9.0-alpha-1.9.7.34",
  "status": "draft",
  "id": "991578b2-b135-4c55-ad28-fa02daf59474",
  "kind": null,
  "url": "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-gambling-questionnaire-template",
  "version": null
}