{
  "description": "A 'standard' form developed using FHIR-based Questionnaire tools intended to demonstrate the range of Questionnaire capabilities needed by form fillers",
  "_filename": "examples/20250321Hematology.json",
  "package_name": "ca.on.oh",
  "subjectType": [ "Patient" ],
  "date": "2025-03-21T21:47:22.960+00:00",
  "publisher": "Ontario Health & eHealth Centre of Excellence",
  "approvalDate": "2025-03-21",
  "name": null,
  "item": [ {
    "item": [ {
      "text": "Surname:",
      "type": "string",
      "linkId": "patient_surname",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-definitionExtractValue",
        "extension": [ {
          "url": "definition",
          "valueUri": "http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Patient#Patient.name.use"
        }, {
          "url": "fixed-value",
          "valueString": "official"
        } ]
      }, {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-definitionExtract",
        "extension": [ {
          "url": "definition",
          "valueCanonical": "http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Patient"
        } ]
      } ],
      "definition": "http://ehealthontario.ca/fhir/StructureDefinition/ca-on-eReferral-profile-Patient#Patient.name.family"
    }, {
      "text": "First Name",
      "type": "string",
      "linkId": "patient_firstname"
    }, {
      "text": "DOB:",
      "type": "date",
      "linkId": "patient_date_of_birth",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
        "valueString": "yyyy/MM/dd"
      } ]
    }, {
      "text": "Gender:",
      "type": "choice",
      "linkId": "patient_gender",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "radio-button",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Radio Button"
          } ]
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
        "valueUrl": "http://hl7.org/fhir/administrative-gender"
      } ],
      "answerOption": [ {
        "valueCoding": {
          "code": "male",
          "system": "http://hl7.org/fhir/administrative-gender",
          "display": "Male"
        }
      }, {
        "valueCoding": {
          "code": "female",
          "system": "http://hl7.org/fhir/administrative-gender",
          "display": "Female"
        }
      }, {
        "valueCoding": {
          "code": "other",
          "system": "http://hl7.org/fhir/administrative-gender",
          "display": "Other"
        }
      } ]
    }, {
      "item": [ {
        "text": "HN:",
        "type": "integer",
        "linkId": "patient_hc_number",
        "maxLength": 10
      }, {
        "text": "HN VC:",
        "type": "string",
        "linkId": "patient_hc_vc",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/minLength",
          "valueInteger": 2
        } ]
      } ],
      "text": "HN PC:",
      "type": "string",
      "linkId": "patient_hc_pc",
      "maxLength": 2
    }, {
      "item": [ {
        "text": "Address (Line 2):",
        "type": "string",
        "linkId": "patient_address_line2"
      }, {
        "text": "City:",
        "type": "string",
        "linkId": "patient_address_city"
      }, {
        "text": "Province:",
        "type": "string",
        "linkId": "patient_address_province",
        "maxLength": 2
      }, {
        "text": "Postal Code:",
        "type": "string",
        "linkId": "patient_address_postalcode",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/regex",
          "valueString": "/^[ABCEGHJ-NPRSTVXY]\\d[ABCEGHJ-NPRSTV-Z][ -]?\\d[ABCEGHJ-NPRSTV-Z]\\d$/i"
        } ]
      } ],
      "text": "Address (Line 1):",
      "type": "string",
      "linkId": "patient_address_line1"
    }, {
      "text": "Mobile #:",
      "type": "string",
      "linkId": "patient_phone_mobile",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/regex",
        "valueString": "^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$"
      } ]
    }, {
      "text": "Home #:",
      "type": "string",
      "linkId": "patient_phone_home",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/regex",
        "valueString": "^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$"
      } ]
    }, {
      "text": "Business #:",
      "type": "string",
      "linkId": "patient_phone_business",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/regex",
        "valueString": "^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$"
      } ]
    }, {
      "text": "Email:",
      "type": "string",
      "linkId": "patient_email",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/regex",
        "valueString": "(?:[a-z0-9!#$%&'*+/=?^_`{|}~-]+(?:\\.[a-z0-9!#$%&'*+/=?^_`{|}~-]+)*|\"(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21\\x23-\\x5b\\x5d-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])*\")@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21-\\x5a\\x53-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])+)\\])"
      } ]
    } ],
    "text": "Patient Information",
    "type": "group",
    "_text": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
        "valueString": "Patient Information"
      } ]
    },
    "linkId": "patient_header",
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
      "valueCodeableConcept": {
        "coding": [ {
          "code": "list",
          "system": "http://hl7.org/fhir/questionnaire-item-control",
          "display": "List"
        } ]
      }
    } ]
  }, {
    "item": [ {
      "text": "Sex assigned at birth:",
      "type": "choice",
      "linkId": "additionalinfo_sexassignedatbirth",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "radio-button",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Radio Button"
          } ]
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
        "valueUrl": "http://example.org/mytxserver"
      } ],
      "answerOption": [ {
        "valueCoding": {
          "code": "LA3-6",
          "system": "http://loinc.org",
          "display": "Female"
        }
      }, {
        "valueCoding": {
          "code": "LA2-8",
          "system": "http://loinc.org",
          "display": "Male"
        }
      }, {
        "valueCoding": {
          "display": "Intersex"
        }
      }, {
        "valueCoding": {
          "code": "LA4489-6",
          "system": "http://loinc.org",
          "display": "Unknown"
        }
      } ]
    }, {
      "item": [ {
        "text": "Other pronouns:",
        "type": "string",
        "linkId": "additionalinfo_pronouns_other",
        "required": true,
        "enableWhen": [ {
          "operator": "=",
          "question": "additionalinfo_pronouns",
          "answerCoding": {
            "display": "Other"
          }
        } ],
        "enableBehavior": "all"
      } ],
      "text": "Pronouns:",
      "type": "choice",
      "linkId": "additionalinfo_pronouns",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "radio-button",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Radio Button"
          } ]
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
        "valueUrl": "http://terminology.hl7.org/ValueSet/pronouns"
      } ],
      "answerOption": [ {
        "valueCoding": {
          "code": "LA29519-8",
          "system": "http://loinc.org",
          "display": "she/her/her/hers/herself"
        }
      }, {
        "valueCoding": {
          "code": "LA29518-0",
          "system": "http://loinc.org",
          "display": "he/him/his/his/himself"
        }
      }, {
        "valueCoding": {
          "code": "LA29520-6",
          "system": "http://loinc.org",
          "display": "they/them/their/theirs/themselves"
        }
      }, {
        "valueCoding": {
          "code": "LA46-8",
          "system": "http://loinc.org",
          "display": "Other"
        }
      } ]
    }, {
      "text": "Preferred name",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "additionalinfo_preferredname_select",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Preferred Name"
        }
      } ]
    }, {
      "text": "Prefered name String",
      "type": "string",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "additionalinfo_preferredname",
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_preferredname_select",
        "answerCoding": {
          "display": "Preferred Name"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "item": [ {
        "text": "Specify:",
        "type": "string",
        "linkId": "additionalinfo_preferredlanguage_specify",
        "required": true,
        "enableWhen": [ {
          "operator": "=",
          "question": "additionalinfo_preferredlanguage",
          "answerCoding": {
            "display": "Other"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "Translator required",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "additionalinfo_preferredlanguage_translatorrequired",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "enableWhen": [ {
          "operator": "=",
          "question": "additionalinfo_preferredlanguage",
          "answerCoding": {
            "display": "Other"
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "code": "true",
            "display": "Translator Required"
          }
        } ]
      } ],
      "text": "Preferred language:",
      "type": "choice",
      "linkId": "additionalinfo_preferredlanguage",
      "required": false,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "radio-button",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Radio Button"
          } ]
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
        "valueUrl": "http://ehealthontario.ca/fhir/ValueSet/human-language"
      } ],
      "answerOption": [ {
        "valueCoding": {
          "code": "en",
          "display": "English"
        }
      }, {
        "valueCoding": {
          "code": "fr",
          "display": "French"
        }
      }, {
        "valueCoding": {
          "display": "Other"
        }
      } ]
    }, {
      "item": [ {
        "enableBehavior": "any",
        "linkId": "additionalinfo_bestmethodofcontact_voicemails",
        "repeats": true,
        "type": "choice",
        "enableWhen": [ {
          "operator": "=",
          "question": "additionalinfo_bestmethodofcontact",
          "answerCoding": {
            "code": "mobile",
            "system": "http://hl7.org/fhir/contact-point-use",
            "display": "Mobile"
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Voicemails acceptable"
          }
        } ],
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "text": "Voicemails acceptable"
      } ],
      "text": "Best method of contact:",
      "type": "choice",
      "linkId": "additionalinfo_bestmethodofcontact",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "radio-button",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Radio Button"
          } ]
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
        "valueUrl": "http://hl7.org/fhir/ValueSet/contact-point-system"
      } ],
      "answerOption": [ {
        "valueCoding": {
          "code": "mobile",
          "system": "http://hl7.org/fhir/contact-point-use",
          "display": "Mobile"
        }
      }, {
        "valueCoding": {
          "code": "home",
          "system": "http://hl7.org/fhir/contact-point-use",
          "display": "Home"
        }
      }, {
        "valueCoding": {
          "code": "work",
          "system": "http://hl7.org/fhir/contact-point-use",
          "display": "Work"
        }
      }, {
        "valueCoding": {
          "code": "email",
          "system": "http://hl7.org/fhir/contact-point-system",
          "display": "Email"
        }
      } ]
    }, {
      "text": "Alternate contact",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "additionalinfo_alternatecontact_select",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
        "valueUrl": "https://fhir.infoway-inforoute.ca/ValueSet/sharedyesnounknown"
      } ],
      "answerOption": [ {
        "valueCoding": {
          "code": "Y",
          "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
          "display": "Alternate contact"
        }
      } ]
    }, {
      "text": "Name:",
      "type": "string",
      "linkId": "additionalinfo_alternatecontact_name",
      "required": true,
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_alternatecontact_select",
        "answerCoding": {
          "code": "Y",
          "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
          "display": "Alternate contact"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Alternate contact phone #:",
      "type": "string",
      "linkId": "additionalinfo_alternatecontact_phone",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/regex",
        "valueString": "^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$"
      } ],
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_alternatecontact_select",
        "answerCoding": {
          "code": "Y",
          "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
          "display": "Alternate contact"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Relationship:",
      "type": "string",
      "linkId": "additionalinfo_alternatecontact_relationship",
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_alternatecontact_select",
        "answerCoding": {
          "code": "Y",
          "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
          "display": "Alternate contact"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Is Alternate contact the appointment booking contact?:",
      "type": "choice",
      "linkId": "additionalinfo_alternatecontact_bookingcontact",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "radio-button",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Radio Button"
          } ]
        }
      } ],
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_alternatecontact_select",
        "answerCoding": {
          "display": "Alternate contact"
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Yes"
        }
      }, {
        "valueCoding": {
          "display": "No"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Unsafe contact persons (do not speak with)",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "additionalinfo_unsafecontacts_select",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Unsafe contact persons (do not speak with)"
        }
      } ]
    }, {
      "enableBehavior": "all",
      "linkId": "additionalinfo_unsafecontacts_speakwithpatientdirectly",
      "repeats": true,
      "type": "choice",
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_unsafecontacts_select",
        "answerCoding": {
          "display": "Unsafe contact persons (do not speak with)"
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Only speak with patient directly"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "text": "Only speak with patient directly"
    }, {
      "text": "Do not speak with:",
      "type": "string",
      "linkId": "additionalinfo_unsafecontacts_donotspeakwith",
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_unsafecontacts_select",
        "answerCoding": {
          "display": "Unsafe contact persons (do not speak with)"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Accessibility concerns or disability",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "additionalinfo_accessibilityconcernsordisability_select",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Accessibility concerns or disability"
        }
      } ]
    }, {
      "text": "Accessibility concerns Options",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "additionalinfo_accessibilityconcernsordisability",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "enableWhen": [ {
        "operator": "=",
        "question": "additionalinfo_accessibilityconcernsordisability_select",
        "answerCoding": {
          "display": "Accessibility concerns or disability"
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Falls risk"
        }
      }, {
        "valueCoding": {
          "display": "Patient requires lift"
        }
      }, {
        "valueCoding": {
          "display": "Wheelchair"
        }
      }, {
        "valueCoding": {
          "display": "Hearing impaired"
        }
      } ]
    }, {
      "text": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)",
      "type": "choice",
      "_text": {
        "extension": [ {
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          "valueString": "
"
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      "linkId": "additionalinfo_specialconsiderations_select",
      "repeats": true,
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          "display": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
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      "type": "text",
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        "answerCoding": {
          "display": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
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    }, {
      "text": "Send copies of reports to additional providers",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
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      "linkId": "additionalinfo_sendcopiestoadditionalproviders",
      "repeats": true,
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      "answerOption": [ {
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          "display": "Send copies of reports to additional providers"
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    }, {
      "item": [ {
        "text": "Contact information:",
        "type": "string",
        "linkId": "additionalinfo_sendcopiestoadditionalproviders_contactinfo",
        "required": true,
        "enableWhen": [ {
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          "question": "additionalinfo_sendcopiestoadditionalproviders",
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            "display": "Send copies of reports to additional providers"
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        "enableBehavior": "all"
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        "enableBehavior": "all",
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        "answerOption": [ {
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            "display": "This is the Primary Care Provider"
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"
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        },
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      "linkId": "additionalinfo_sendcopiestoadditionalproviders_names",
      "required": true,
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        "answerCoding": {
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      "enableBehavior": "all"
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    "text": "[Optional] Additional Patient Information",
    "type": "group",
    "_text": {
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        "valueString": "
[Optional] Additional Patient Information
"
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    },
    "linkId": "additionalinfo_header"
  }, {
    "item": [ {
      "item": [ {
        "item": [ {
          "text": "Reason for urgent triage",
          "type": "string",
          "linkId": "referral_requestedpriority_urgentreason",
          "required": true,
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            "question": "referral_requestedpriority",
            "answerCoding": {
              "display": "Urgent"
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        "text": "Requested Priority:",
        "type": "choice",
        "linkId": "referral_requestedpriority",
        "required": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "radio-button",
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        "answerOption": [ {
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            "display": "Urgent"
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          "valueCoding": {
            "display": "Routine"
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          "initialSelected": true
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      }, {
        "text": "Second Opinion",
        "type": "choice",
        "_text": {
          "extension": [ {
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            "valueString": "
"
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        "linkId": "referral_secondopinion",
        "repeats": true,
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        "answerOption": [ {
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            "display": "Second Opinion"
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        "text": "Reason for second opinion:",
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        "linkId": "referral_secondopinion_reason",
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          "question": "referral_secondopinion",
          "answerCoding": {
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      "text": "Triage Considerations",
      "type": "group",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
Triage Considerations
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      },
      "linkId": "552020330847"
    }, {
      "item": [ {
        "item": [ {
          "text": "Display Clinical Decision Support (CDS)",
          "type": "choice",
          "linkId": "833950848242",
          "extension": [ {
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            "valueCodeableConcept": {
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          "answerOption": [ {
            "valueCoding": {
              "display": "Hide"
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            "initialSelected": true
          }, {
            "valueCoding": {
              "display": "Show"
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          } ]
        }, {
          "text": "CDS is hidden for selections below. Click 'Show' to display where available.",
          "type": "display",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
CDS is hidden for selections below. Click 'Show' to display where available.  
"
            } ]
          },
          "linkId": "527028368186",
          "enableWhen": [ {
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            "question": "833950848242",
            "answerCoding": {
              "display": "Hide"
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          } ],
          "enableBehavior": "all"
        }, {
          "text": "CDS will show for selections below where available. Click 'Hide' to remove.",
          "type": "display",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
CDS will show for selections below where available. Click 'Hide' to remove. 
"
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          },
          "linkId": "808343173211",
          "enableWhen": [ {
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            "question": "833950848242",
            "answerCoding": {
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            }
          } ],
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        } ],
        "text": "CDS Section",
        "type": "group",
        "_text": {
          "extension": [ {
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            "valueString": "
"
          } ]
        },
        "linkId": "763910172792"
      }, {
        "text": "Select all that apply:",
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        "_text": {
          "extension": [ {
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            "valueString": "
Select all that apply:
"
          } ]
        },
        "linkId": "263473045995"
      }, {
        "text": "Bicytopenia or Pancytopenia (decreases in more than one cell line)",
        "type": "choice",
        "_text": {
          "extension": [ {
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            "valueString": "
"
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        "linkId": "694055681546",
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        "extension": [ {
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            "display": "Bicytopenia or Pancytopenia (decreases in more than one cell line)"
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      }, {
        "item": [ {
          "text": "Bicytopenia or Pancytopenia CDS",
          "type": "display",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Blood Film
Vitamin B12
TSH
Reticulocyte Count
Liver Enzymes
Creatinine
HIV Test
Hepatitis Test
Autoimmune screen (ANA, RF, anti dsDNA)
Consider abdominal Ultrasound
"
            } ]
          },
          "linkId": "314056938386"
        } ],
        "text": "Bicytopenia or Pancytopenia Section",
        "type": "group",
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          "question": "833950848242",
          "answerCoding": {
            "display": "Show"
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        } ],
        "enableBehavior": "all"
      }, {
        "text": "Bleeding or Abnormal INR/PTT",
        "type": "choice",
        "_text": {
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"
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        "linkId": "977297748115",
        "repeats": true,
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            "display": "Bleeding or Abnormal INR/PTT"
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        } ]
      }, {
        "item": [ {
          "text": "Labs abnormal - no bleeding / bruising",
          "type": "choice",
          "_text": {
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"
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              "display": "Labs abnormal - no bleeding / bruising"
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        }, {
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            "text": "Labs abnormal - no bleeding / bruising CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Ferritin
Liver Enzymes
Creatinine
INR
PTT
Albumin
Fibrinogen
"
              } ]
            },
            "linkId": "562307835996"
          } ],
          "text": "Labs abnormal - no bleeding / bruising Section",
          "type": "group",
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              "display": "Labs abnormal - no bleeding / bruising"
            }
          }, {
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            "answerCoding": {
              "display": "Bleeding or Abnormal INR/PTT"
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          "enableBehavior": "all"
        }, {
          "text": "Abnormal bleeding / bruising",
          "type": "choice",
          "_text": {
            "extension": [ {
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              "valueString": "
"
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          "repeats": true,
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                "code": "check-box",
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          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Abnormal bleeding / bruising"
            }
          } ]
        }, {
          "item": [ {
            "text": "Abnormal bleeding / bruising CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Ferritin
Liver Enzymes
Creatinine
INR
PTT
Albumin
Fibrinogen
"
              } ]
            },
            "linkId": "359678688658"
          } ],
          "text": "Abnormal bleeding / bruising Section",
          "type": "group",
          "_text": {
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              "valueString": "
"
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          "linkId": "820329472101",
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            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "977297748115",
            "answerCoding": {
              "display": "Bleeding or Abnormal INR/PTT"
            }
          }, {
            "operator": "=",
            "question": "872311415115",
            "answerCoding": {
              "display": "Abnormal bleeding / bruising"
            }
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        } ],
        "text": "Bleeding or Abnormal INR/PTT Section",
        "type": "group",
        "_text": {
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            "valueString": "
"
          } ]
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        "linkId": "325278393091",
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          "answerCoding": {
            "display": "Bleeding or Abnormal INR/PTT"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "Confirmed Malignant Hematology Consultation (biopsy proven)",
        "type": "choice",
        "_text": {
          "extension": [ {
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            "valueString": "
"
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        "linkId": "889495603331",
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              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Confirmed Malignant Hematology Consultation (biopsy proven)"
          }
        } ]
      }, {
        "text": "Red Blood Cells or Iron",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "583392601629",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Red Blood Cells or Iron"
          }
        } ]
      }, {
        "item": [ {
          "text": "Anemia NYD",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
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          "linkId": "467935752823",
          "repeats": true,
          "extension": [ {
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            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Anemia NYD"
            }
          } ]
        }, {
          "item": [ {
            "text": "Anemia NYD CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Blood Film
Ferritin
Vitamin B12
Reticulocyte Count
Liver Enzymes
Creatinine
SPEP with immunofixation
LDH
Order hemoglobin electrophoresis if mirocytic with normal ferritin levels
"
              } ]
            },
            "linkId": "107794695427"
          } ],
          "text": "Anemia NYD Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
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          "linkId": "210574639736",
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          }, {
            "operator": "=",
            "question": "467935752823",
            "answerCoding": {
              "display": "Anemia NYD"
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          }, {
            "operator": "=",
            "question": "583392601629",
            "answerCoding": {
              "display": "Red Blood Cells or Iron"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Anemia - Iron Deficiency",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "717334309196",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Anemia - Iron Deficiency"
            }
          } ]
        }, {
          "item": [ {
            "text": "Anemia - Iron Deficiency CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Referral Guidance:
Please ensure patients have been evaluated by gastroenterology or gynecology to rule out occult blood loss before referral, if indicated.
Referrals are best considered after patients have been treated with optimal doses of iron for at least 6 months with good compliance.
Suggested investigations to include with referral: 
CBC
Repeat ferritin
Vitamin B12
Reticulocyte Count
Liver Enzymes
Creatinine
Consider celiac disease screen (anti-TTG)
"
              } ]
            },
            "linkId": "737692129617"
          } ],
          "text": "Anemia - Iron Deficiency Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "449734071462",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "717334309196",
            "answerCoding": {
              "display": "Anemia - Iron Deficiency"
            }
          }, {
            "operator": "=",
            "question": "583392601629",
            "answerCoding": {
              "display": "Red Blood Cells or Iron"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Erythrocytosis",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "521711697185",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Erythrocytosis"
            }
          } ]
        }, {
          "item": [ {
            "text": "Erythrocytosis CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Ferritin
Erythroproietin levels
"
              } ]
            },
            "linkId": "159072941371"
          } ],
          "text": "Erythrocytosis Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "500469019267",
          "enableWhen": [ {
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            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
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          }, {
            "operator": "=",
            "question": "521711697185",
            "answerCoding": {
              "display": "Erythrocytosis"
            }
          }, {
            "operator": "=",
            "question": "583392601629",
            "answerCoding": {
              "display": "Red Blood Cells or Iron"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Ferritin - High",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          },
          "linkId": "320126575411",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
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                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Ferritin - High"
            }
          } ]
        }, {
          "item": [ {
            "text": "Ferritin - High CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Repeat ferritin
Serum Iron
Total iron binding capacity
Transferrin saturation
CRP
Liver enzymes and function
Fasting glucose (or HbA1C) and lipids
TSH
Consider abdominal Ultrasound
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              } ]
            },
            "linkId": "327594323460"
          } ],
          "text": "Ferritin - High Section",
          "type": "group",
          "_text": {
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              "valueString": "
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            } ]
          },
          "linkId": "744933528744",
          "enableWhen": [ {
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            "question": "320126575411",
            "answerCoding": {
              "display": "Ferritin - High"
            }
          }, {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "583392601629",
            "answerCoding": {
              "display": "Red Blood Cells or Iron"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Other Hemoglobinopathy",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "591220857170",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Other Hemoglobinopathy"
            }
          } ]
        }, {
          "item": [ {
            "text": "Sickle Cell Disease",
            "type": "choice",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
"
              } ]
            },
            "linkId": "872407521897",
            "repeats": true,
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [ {
                  "code": "check-box",
                  "system": "http://hl7.org/fhir/questionnaire-item-control",
                  "display": "Check-box"
                } ]
              }
            } ],
            "answerOption": [ {
              "valueCoding": {
                "display": "Sickle Cell Disease"
              }
            } ]
          }, {
            "text": "Thallasemias",
            "type": "choice",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
"
              } ]
            },
            "linkId": "920764077010",
            "repeats": true,
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [ {
                  "code": "check-box",
                  "system": "http://hl7.org/fhir/questionnaire-item-control",
                  "display": "Check-box"
                } ]
              }
            } ],
            "answerOption": [ {
              "valueCoding": {
                "display": "Thallasemias"
              }
            } ]
          }, {
            "text": "Other Hemoglobinopathy",
            "type": "choice",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
"
              } ]
            },
            "linkId": "208765669370",
            "repeats": true,
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [ {
                  "code": "check-box",
                  "system": "http://hl7.org/fhir/questionnaire-item-control",
                  "display": "Check-box"
                } ]
              }
            } ],
            "answerOption": [ {
              "valueCoding": {
                "display": "Hemoglobinopathy"
              }
            } ]
          }, {
            "text": "Specify:",
            "type": "string",
            "linkId": "233559390907",
            "required": true,
            "enableWhen": [ {
              "operator": "=",
              "question": "208765669370",
              "answerCoding": {
                "display": "Hemoglobinopathy"
              }
            } ],
            "enableBehavior": "all"
          }, {
            "text": "Other Hemoglobinopathy CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Blood Film
Ferritin
Hemoglobin electrophoresis
Liver Enzymes
Creatinine
LDH
"
              } ]
            },
            "linkId": "696697234965",
            "enableWhen": [ {
              "operator": "=",
              "question": "833950848242",
              "answerCoding": {
                "display": "Show"
              }
            }, {
              "operator": "=",
              "question": "583392601629",
              "answerCoding": {
                "display": "Red Blood Cells or Iron"
              }
            }, {
              "operator": "=",
              "question": "591220857170",
              "answerCoding": {
                "display": "Other Hemoglobinopathy"
              }
            } ],
            "enableBehavior": "all"
          } ],
          "text": "Other Hemoglobinopathy Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "459811379061",
          "enableWhen": [ {
            "operator": "=",
            "question": "591220857170",
            "answerCoding": {
              "display": "Other Hemoglobinopathy"
            }
          }, {
            "operator": "=",
            "question": "583392601629",
            "answerCoding": {
              "display": "Red Blood Cells or Iron"
            }
          } ],
          "enableBehavior": "all"
        } ],
        "text": "Red Blood Cells or Iron Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
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          } ]
        },
        "linkId": "411100709183",
        "enableWhen": [ {
          "operator": "=",
          "question": "583392601629",
          "answerCoding": {
            "display": "Red Blood Cells or Iron"
          }
        } ]
      }, {
        "text": "Myeloma or Paraproteinemia (e.g. Bence Jones proteinuria, monoclonal gammopathy)",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
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          } ]
        },
        "linkId": "148436126268",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Myeloma or Paraproteinemia (e.g. Bence Jones proteinuria, monoclonal gammopathy)"
          }
        } ]
      }, {
        "item": [ {
          "text": "Myeloma or Paraproteinemia CDS",
          "type": "display",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
Suggested investigations to include with referral: 
CBC
Repeat SPEP (if last >6 months prior) with Immunofixation (IFE)
Quantitative immunoglobulins
Creatinine
Calcium
Albumin
Serum free light chain ratio (FLC) or urine Bence-Jones protein
Consider Skeletal Bone Survey if pain
"
            } ]
          },
          "linkId": "911764125934"
        } ],
        "text": "Myeloma or Paraproteinemia Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "492391914505",
        "enableWhen": [ {
          "operator": "=",
          "question": "833950848242",
          "answerCoding": {
            "display": "Show"
          }
        }, {
          "operator": "=",
          "question": "148436126268",
          "answerCoding": {
            "display": "Myeloma or Paraproteinemia (e.g. Bence Jones proteinuria, monoclonal gammopathy)"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "Lymph Nodes or Spleen",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
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          } ]
        },
        "linkId": "904715324432",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Lymph Nodes or Spleen"
          }
        } ]
      }, {
        "item": [ {
          "text": "Lymphadenopathy - Concern for Lymphoma",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "708287470095",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Lymphadenopathy - Concern for Lymphoma"
            }
          } ]
        }, {
          "item": [ {
            "text": "Lymphadenopathy - Concern for Lymphoma CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Pathology Report of Tissue Biopsy
CBC
Creatinine
Liver enzymes
Albumin
"
              } ]
            },
            "linkId": "437131689550"
          } ],
          "text": "Lymphadenopathy - Concern for Lymphoma Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "929410278073",
          "enableWhen": [ {
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            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "904715324432",
            "answerCoding": {
              "display": "Lymph Nodes or Spleen"
            }
          }, {
            "operator": "=",
            "question": "708287470095",
            "answerCoding": {
              "display": "Lymphadenopathy - Concern for Lymphoma"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Lymphoma",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "798234191452",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Lymphoma"
            }
          } ]
        }, {
          "item": [ {
            "text": "Lymphoma CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Pathology Report of Tissue Biopsy
CBC
Creatinine
Liver enzymes
Albumin
"
              } ]
            },
            "linkId": "689085741978"
          } ],
          "text": "Lymphoma Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "200176481540",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "904715324432",
            "answerCoding": {
              "display": "Lymph Nodes or Spleen"
            }
          }, {
            "operator": "=",
            "question": "798234191452",
            "answerCoding": {
              "display": "Lymphoma"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Splenomegaly",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "411182144926",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Splenomegaly"
            }
          } ]
        }, {
          "item": [ {
            "text": "Splenomegaly CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Blood Film
Reticulocyte Count
Liver Enzymes
LDH
Monospot
HIV Test
Quantitative immunoglobulins
Abdominal Ultrasound
"
              } ]
            },
            "linkId": "704150848338"
          } ],
          "text": "Splenomegaly Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "915460164752",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "904715324432",
            "answerCoding": {
              "display": "Lymph Nodes or Spleen"
            }
          }, {
            "operator": "=",
            "question": "411182144926",
            "answerCoding": {
              "display": "Splenomegaly"
            }
          } ],
          "enableBehavior": "all"
        } ],
        "text": "Lymph Nodes or Spleen Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "424678845059",
        "enableWhen": [ {
          "operator": "=",
          "question": "904715324432",
          "answerCoding": {
            "display": "Lymph Nodes or Spleen"
          }
        } ]
      }, {
        "text": "Platelets",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "353533846391",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Platelets"
          }
        } ]
      }, {
        "item": [ {
          "text": "Thrombocytopenia (low platelets)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "684933989555",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Thrombocytopenia (low platelets)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Thrombocytopenia (low platelets) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Blood Film
TSH
Liver Enzymes
HIV Test
Hepatitis C and B Testing
H Pylori Serology
Autoimmune Screen (ANA, RF, dsDNA)
Pregnancy test if woman of childbearing age
"
              } ]
            },
            "linkId": "951277286533"
          } ],
          "text": "Thrombocytopenia (low platelets) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "272273757682",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "684933989555",
            "answerCoding": {
              "display": "Thrombocytopenia (low platelets)"
            }
          }, {
            "operator": "=",
            "question": "353533846391",
            "answerCoding": {
              "display": "Platelets"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Thrombocytosis (high platelets)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "549883242111",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Thrombocytosis (high platelets)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Thrombocytosis (high platelets) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Blood Film
Ferritin
CRP
Liver Enzymes
Creatinine
"
              } ]
            },
            "linkId": "607723911967"
          } ],
          "text": "Thrombocytosis (high platelets) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "287829917608",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "549883242111",
            "answerCoding": {
              "display": "Thrombocytosis (high platelets)"
            }
          }, {
            "operator": "=",
            "question": "353533846391",
            "answerCoding": {
              "display": "Platelets"
            }
          } ],
          "enableBehavior": "all"
        } ],
        "text": "Platelets Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "417127260553",
        "enableWhen": [ {
          "operator": "=",
          "question": "353533846391",
          "answerCoding": {
            "display": "Platelets"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "Thrombosis",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "107156661062",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
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          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Thrombosis"
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        } ]
      }, {
        "item": [ {
          "text": "Atrial Fibrillation Anticoagulation",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "694062779278",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Atrial Fibrillation Anticoagulation"
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          } ]
        }, {
          "item": [ {
            "text": "Atrial Fibrillation Anticoagulation CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
ECG or Holter monitor to confirm presence of atrial fibrillation
CBC
Creatinine
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              } ]
            },
            "linkId": "897689410391"
          } ],
          "text": "Atrial Fibrillation Anticoagulation Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          },
          "linkId": "113347366982",
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            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
            }
          }, {
            "operator": "=",
            "question": "694062779278",
            "answerCoding": {
              "display": "Atrial Fibrillation Anticoagulation"
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          } ],
          "enableBehavior": "all"
        }, {
          "text": "Mechanical Valve Anticoagulation",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "280007718982",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Mechanical Valve Anticoagulation"
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          } ]
        }, {
          "item": [ {
            "text": "Mechanical Valve Anticoagulation CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Creatinine
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              } ]
            },
            "linkId": "885413464577"
          } ],
          "text": "Mechanical Valve Anticoagulation Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "758240802363",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
            }
          }, {
            "operator": "=",
            "question": "280007718982",
            "answerCoding": {
              "display": "Mechanical Valve Anticoagulation"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Peripartum Thrombosis - Prevention or Treatment",
          "type": "choice",
          "_text": {
            "extension": [ {
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              "valueString": "
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          },
          "linkId": "161777501382",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Peripartum Thrombosis - Prevention or Treatment"
            }
          } ]
        }, {
          "item": [ {
            "text": "Peripartum Thrombosis - Prevention or Treatment CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Diagnostic imaging confirming clot
CBC
Creatinine
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            },
            "linkId": "991733072782"
          } ],
          "text": "Peripartum Thrombosis - Prevention or Treatment Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          },
          "linkId": "198159713420",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
            }
          }, {
            "operator": "=",
            "question": "161777501382",
            "answerCoding": {
              "display": "Peripartum Thrombosis - Prevention or Treatment"
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          } ],
          "enableBehavior": "all"
        }, {
          "text": "Peri-procedure Anticoagulation Management",
          "type": "choice",
          "_text": {
            "extension": [ {
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              "valueString": "
"
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          },
          "linkId": "767750157468",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Peri-procedure Anticoagulation Management"
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          } ]
        }, {
          "item": [ {
            "text": "For triage/urgency assessment. Please provide the following, if known:",
            "type": "display",
            "linkId": "159410096641"
          }, {
            "text": "Procedure Date:",
            "type": "date",
            "linkId": "632696036005",
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
              "valueString": "yyyy/MM/dd"
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          }, {
            "text": "Procedure Type:",
            "type": "string",
            "linkId": "184030039015"
          }, {
            "text": "Peri-procedure Anticoagulation Management CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Creatinine
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            },
            "linkId": "855389898307",
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              "question": "833950848242",
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                "display": "Show"
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            }, {
              "operator": "=",
              "question": "107156661062",
              "answerCoding": {
                "display": "Thrombosis"
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            }, {
              "operator": "=",
              "question": "767750157468",
              "answerCoding": {
                "display": "Peri-procedure Anticoagulation Management"
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            } ],
            "enableBehavior": "all"
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          "text": "Peri-procedure Anticoagulation Management Section",
          "type": "group",
          "_text": {
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          },
          "linkId": "869735990927",
          "enableWhen": [ {
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            "question": "107156661062",
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              "display": "Thrombosis"
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          }, {
            "operator": "=",
            "question": "767750157468",
            "answerCoding": {
              "display": "Peri-procedure Anticoagulation Management"
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          } ],
          "enableBehavior": "all"
        }, {
          "text": "Superficial Vein Thrombosis",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          },
          "linkId": "271536168850",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Superficial Vein Thrombosis"
            }
          } ]
        }, {
          "item": [ {
            "text": "Superficial Vein Thrombosis CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Diagnostic imaging confirming clot
CBC
Creatinine
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              } ]
            },
            "linkId": "112455668015"
          } ],
          "text": "Superficial Vein Thrombosis Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          },
          "linkId": "766495926365",
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            "question": "833950848242",
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              "display": "Show"
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            "question": "107156661062",
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              "display": "Thrombosis"
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          }, {
            "operator": "=",
            "question": "271536168850",
            "answerCoding": {
              "display": "Superficial Vein Thrombosis"
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          } ],
          "enableBehavior": "all"
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          "text": "Thrombophilia",
          "type": "choice",
          "_text": {
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              "valueString": "
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          },
          "linkId": "701364395061",
          "repeats": true,
          "extension": [ {
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                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Thrombophilia"
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          } ]
        }, {
          "item": [ {
            "text": "Thrombophilia CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Diagnostic imaging confirming clot
CBC
Creatinine
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            },
            "linkId": "634896289359"
          } ],
          "text": "Thrombophilia Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          }, {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
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          }, {
            "operator": "=",
            "question": "701364395061",
            "answerCoding": {
              "display": "Thrombophilia"
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          } ],
          "enableBehavior": "all"
        }, {
          "text": "Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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          },
          "linkId": "660186773827",
          "repeats": true,
          "extension": [ {
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            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Diagnostic imaging confirming clot
CBC
Creatinine
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            },
            "linkId": "464301464184"
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          "text": "Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE) Section",
          "type": "group",
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              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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          }, {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
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          }, {
            "operator": "=",
            "question": "660186773827",
            "answerCoding": {
              "display": "Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE)"
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          "enableBehavior": "all"
        }, {
          "text": "Venous Thromboembolism - Chronic (e.g. DVT, PE)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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          },
          "linkId": "427264680316",
          "repeats": true,
          "extension": [ {
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            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Venous Thromboembolism - Chronic (e.g. DVT, PE)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Venous Thromboembolism - Chronic (e.g. DVT, PE) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Diagnostic imaging confirming clot
CBC
Creatinine
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              } ]
            },
            "linkId": "503707165781"
          } ],
          "text": "Venous Thromboembolism - Chronic (e.g. DVT, PE) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "563328083913",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
            }
          }, {
            "operator": "=",
            "question": "427264680316",
            "answerCoding": {
              "display": "Venous Thromboembolism - Chronic (e.g. DVT, PE)"
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          } ],
          "enableBehavior": "all"
        }, {
          "text": "Other Thrombosis Consultation",
          "type": "choice",
          "_text": {
            "extension": [ {
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              "valueString": "
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          },
          "linkId": "580447918184",
          "repeats": true,
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            "valueCodeableConcept": {
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                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Other Thrombosis Consultation"
            }
          } ]
        }, {
          "item": [ {
            "text": "Examples: \"thrombophilia\", \"bleeding risk assessment\", \"reassess duration of anticoagulation\"",
            "type": "display",
            "linkId": "366039255084"
          }, {
            "text": "Specify:",
            "type": "string",
            "linkId": "995382044656",
            "required": true
          } ],
          "text": "Other Thrombosis Consultation Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "370305888280",
          "enableWhen": [ {
            "operator": "=",
            "question": "107156661062",
            "answerCoding": {
              "display": "Thrombosis"
            }
          }, {
            "operator": "=",
            "question": "580447918184",
            "answerCoding": {
              "display": "Other Thrombosis Consultation"
            }
          } ],
          "enableBehavior": "all"
        } ],
        "text": "Thrombosis Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
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          } ]
        },
        "linkId": "847465196796",
        "enableWhen": [ {
          "operator": "=",
          "question": "107156661062",
          "answerCoding": {
            "display": "Thrombosis"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "Transfusion",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "700284220916",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Transfusion"
          }
        } ]
      }, {
        "text": "White Blood Cells",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
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          } ]
        },
        "linkId": "575509800424",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "White Blood Cells"
          }
        } ]
      }, {
        "item": [ {
          "text": "Acute Leukemia (myeloid or lymphoblastic)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
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            } ]
          },
          "linkId": "719899172302",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
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            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Acute Leukemia (myeloid or lymphoblastic)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Acute Leukemia (myeloid or lymphoblastic) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
CBC
Blood film 
Chemistry and extended electrolytes
Tests of Liver Function including amylase and lipase
Coagulation panel
LDH
Uric acid
Creatinine
Available pathology reports (bone marrow, peripheral blood immunophenotyping, cytogenetics, molecular studies)
"
              } ]
            },
            "linkId": "476811833056"
          } ],
          "text": "Acute Leukemia (myeloid or lymphoblastic) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "142565991278",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "575509800424",
            "answerCoding": {
              "display": "White Blood Cells"
            }
          }, {
            "operator": "=",
            "question": "719899172302",
            "answerCoding": {
              "display": "Acute Leukemia (myeloid or lymphoblastic)"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Chronic Leukemia (myeloid or lymphoblastic)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "878179079937",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Chronic Leukemia (myeloid or lymphoblastic)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Chronic Leukemia (myeloid or lymphoblastic) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Blood Film
CRP
Ensure cancer screening (as per age and gender specific guidelines) is up-to-date
"
              } ]
            },
            "linkId": "761131662248"
          } ],
          "text": "Chronic Leukemia (myeloid or lymphoblastic) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "613024453782",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "575509800424",
            "answerCoding": {
              "display": "White Blood Cells"
            }
          }, {
            "operator": "=",
            "question": "878179079937",
            "answerCoding": {
              "display": "Chronic Leukemia (myeloid or lymphoblastic)"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Leukocytosis (high white blood cells)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "796324251583",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Leukocytosis (high white blood cells)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Leukocytosis (high white blood cells) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Repeat CBC
Blood Film
CRP
Ensure cancer screening (as per age and gender specific guidelines) is up-to-date.
"
              } ]
            },
            "linkId": "747472838682"
          } ],
          "text": "Leukocytosis (high white blood cells) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "965811786503",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "575509800424",
            "answerCoding": {
              "display": "White Blood Cells"
            }
          }, {
            "operator": "=",
            "question": "796324251583",
            "answerCoding": {
              "display": "Leukocytosis (high white blood cells)"
            }
          } ],
          "enableBehavior": "all"
        }, {
          "text": "Leukopenia (low white blood cells, including low neutrophil count)",
          "type": "choice",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "369963694471",
          "repeats": true,
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
            "valueCodeableConcept": {
              "coding": [ {
                "code": "check-box",
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "display": "Check-box"
              } ]
            }
          } ],
          "answerOption": [ {
            "valueCoding": {
              "display": "Leukopenia (low white blood cells, including low neutrophil count)"
            }
          } ]
        }, {
          "item": [ {
            "text": "Leukopenia (low white blood cells, including low neutrophil count) CDS",
            "type": "display",
            "_text": {
              "extension": [ {
                "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString": "
Suggested investigations to include with referral: 
Leukopenia:
Repeat CBC
Blood Film
TSH
Liver Enzymes
HIV Test
Hepatitis Test
Autoimmune screen (ANA, RF, anti dsDNA)
Neutropenia:
Repeat CBC
Blood Film
Autoimmune screen (ANA, RF, dsDNA)
Viral serology (EBV; HIV; hepatitis C antibody; hepatitis B surface antigen, surface antibody, and core antibodies)
"
              } ]
            },
            "linkId": "454552436887"
          } ],
          "text": "Leukopenia (low white blood cells, including low neutrophil count) Section",
          "type": "group",
          "_text": {
            "extension": [ {
              "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
              "valueString": "
"
            } ]
          },
          "linkId": "785476966331",
          "enableWhen": [ {
            "operator": "=",
            "question": "833950848242",
            "answerCoding": {
              "display": "Show"
            }
          }, {
            "operator": "=",
            "question": "575509800424",
            "answerCoding": {
              "display": "White Blood Cells"
            }
          }, {
            "operator": "=",
            "question": "369963694471",
            "answerCoding": {
              "display": "Leukopenia (low white blood cells, including low neutrophil count)"
            }
          } ],
          "enableBehavior": "all"
        } ],
        "text": "White Blood Cells Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "518664607900",
        "enableWhen": [ {
          "operator": "=",
          "question": "575509800424",
          "answerCoding": {
            "display": "White Blood Cells"
          }
        } ]
      }, {
        "text": "Other Benign Hematology Consultation",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "864986375143",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Other Benign Hematology Consultation"
          }
        } ]
      }, {
        "item": [ {
          "text": "Specify",
          "type": "text",
          "linkId": "887821345851",
          "required": true
        } ],
        "text": "Other Benign Hematology Consultation Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "318730662948",
        "enableWhen": [ {
          "operator": "=",
          "question": "864986375143",
          "answerCoding": {
            "display": "Other Benign Hematology Consultation"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "Other Malignant Hematology Consultation",
        "type": "choice",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "449017843277",
        "repeats": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "check-box",
              "system": "http://hl7.org/fhir/questionnaire-item-control",
              "display": "Check-box"
            } ]
          }
        } ],
        "answerOption": [ {
          "valueCoding": {
            "display": "Other Malignant Hematology Consultation"
          }
        } ]
      }, {
        "item": [ {
          "text": "Specify",
          "type": "text",
          "linkId": "849145365131",
          "required": true
        } ],
        "text": "Other Malignant Hematology Consultation Section",
        "type": "group",
        "_text": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString": "
"
          } ]
        },
        "linkId": "868013410876",
        "enableWhen": [ {
          "operator": "=",
          "question": "449017843277",
          "answerCoding": {
            "display": "Other Malignant Hematology Consultation"
          }
        } ],
        "enableBehavior": "all"
      }, {
        "text": "C I Validation",
        "type": "string",
        "linkId": "883819985061",
        "required": true,
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
          "valueBoolean": true
        } ],
        "enableWhen": [ {
          "operator": "!=",
          "question": "694055681546",
          "answerCoding": {
            "display": "Bicytopenia or Pancytopenia (decreases in more than one cell line)"
          }
        }, {
          "operator": "!=",
          "question": "977297748115",
          "answerCoding": {
            "display": "Bleeding or Abnormal INR/PTT"
          }
        }, {
          "operator": "!=",
          "question": "889495603331",
          "answerCoding": {
            "display": "Confirmed Malignant Hematology Consultation (biopsy proven)"
          }
        }, {
          "operator": "!=",
          "question": "583392601629",
          "answerCoding": {
            "display": "Red Blood Cells or Iron"
          }
        }, {
          "operator": "!=",
          "question": "148436126268",
          "answerCoding": {
            "display": "Myeloma or Paraproteinemia (e.g. Bence Jones proteinuria, monoclonal gammopathy)"
          }
        }, {
          "operator": "!=",
          "question": "904715324432",
          "answerCoding": {
            "display": "Lymph Nodes or Spleen"
          }
        }, {
          "operator": "!=",
          "question": "353533846391",
          "answerCoding": {
            "display": "Platelets"
          }
        }, {
          "operator": "!=",
          "question": "107156661062",
          "answerCoding": {
            "display": "Thrombosis"
          }
        }, {
          "operator": "!=",
          "question": "700284220916",
          "answerCoding": {
            "display": "Transfusion"
          }
        }, {
          "operator": "!=",
          "question": "575509800424",
          "answerCoding": {
            "display": "White Blood Cells"
          }
        }, {
          "operator": "!=",
          "question": "864986375143",
          "answerCoding": {
            "display": "Other Benign Hematology Consultation"
          }
        }, {
          "operator": "!=",
          "question": "449017843277",
          "answerCoding": {
            "display": "Other Malignant Hematology Consultation"
          }
        } ],
        "enableBehavior": "all"
      } ],
      "text": "Concern(s) / Indication(s) Triggering Referral *",
      "type": "group",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
Concern(s) / Indication(s) Triggering Referral , 0, 0);\">*
"
        } ]
      },
      "linkId": "882448534001"
    }, {
      "text": "Brief Description of Referral, History, Management, and Investigations",
      "type": "text",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "Brief Description of Referral, History, Management, and Investigations"
        } ]
      },
      "linkId": "8318324876210",
      "required": true
    } ],
    "text": "Referral Details",
    "type": "group",
    "_text": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
        "valueString": "
Referral Details
"
      } ]
    },
    "linkId": "687130677379"
  }, {
    "item": [ {
      "text": "CPP attached separately (if not entered below)",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "cpp_separate",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "CPP attached separately (if not entered below)"
        }
      } ]
    }, {
      "text": "Current Problem List:",
      "type": "text",
      "linkId": "cpp_currentprob",
      "enableWhen": [ {
        "operator": "!=",
        "question": "cpp_separate",
        "answerCoding": {
          "display": "CPP attached separately (if not entered below)"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Past Medical History:",
      "type": "text",
      "linkId": "cpp_pastmedicalhistory",
      "enableWhen": [ {
        "operator": "!=",
        "question": "cpp_separate",
        "answerCoding": {
          "display": "CPP attached separately (if not entered below)"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Current Medications :",
      "type": "text",
      "linkId": "cpp_currentmedications",
      "enableWhen": [ {
        "operator": "!=",
        "question": "cpp_separate",
        "answerCoding": {
          "display": "CPP attached separately (if not entered below)"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Family History:",
      "type": "text",
      "linkId": "cpp_familyhistory",
      "enableWhen": [ {
        "operator": "!=",
        "question": "cpp_separate",
        "answerCoding": {
          "display": "CPP attached separately (if not entered below)"
        }
      } ],
      "enableBehavior": "all"
    }, {
      "text": "Allergies:",
      "type": "text",
      "linkId": "cpp_allergies",
      "enableWhen": [ {
        "operator": "!=",
        "question": "cpp_separate",
        "answerCoding": {
          "display": "CPP attached separately (if not entered below)"
        }
      } ],
      "enableBehavior": "all"
    } ],
    "text": "Cumulative Patient Profile",
    "type": "group",
    "_text": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
        "valueString": "Cumulative Patient Profile
\nPlease delete any sensitive information you do not intend to share from the CPP"
      } ]
    },
    "linkId": "cpp_header"
  }, {
    "item": [ {
      "text": "Preferred consultant or location",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "preferredconsultlocation_selector",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Preferred consultant or location"
        }
      } ]
    }, {
      "item": [ {
        "text": "Consultant:",
        "type": "string",
        "linkId": "preferredconsultlocation_consultant"
      }, {
        "text": "Location:",
        "type": "string",
        "linkId": "preferredconsultlocation_location"
      } ],
      "text": "Please specify either a preferred consultant or location",
      "type": "group",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "Please specify either a preferred consultant or location"
        } ]
      },
      "linkId": "preferredconsultlocation_specify",
      "enableWhen": [ {
        "operator": "=",
        "question": "preferredconsultlocation_selector",
        "answerCoding": {
          "display": "Preferred consultant or location"
        }
      } ]
    }, {
      "text": "Patient willing to travel for shorter wait time",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "preferredconsultlocation_willingtotravel",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Patient willing to travel for shorter wait time"
        }
      } ]
    }, {
      "text": "Other considerations:",
      "type": "string",
      "linkId": "preferredconsultlocation_otherconsiderations"
    } ],
    "text": "Preferred Consultant or Location",
    "type": "group",
    "_text": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
        "valueString": "Preferred Consultant or Location
\nAll patients will be triaged to the shortest wait time unless a preferred consultant or location is entered."
      } ]
    },
    "linkId": "preferredconsultlocation_header"
  }, {
    "item": [ {
      "text": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient.",
      "type": "choice",
      "_text": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
          "valueString": "
"
        } ]
      },
      "linkId": "supportingdocumentation_details",
      "repeats": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
        "valueCodeableConcept": {
          "coding": [ {
            "code": "check-box",
            "system": "http://hl7.org/fhir/questionnaire-item-control",
            "display": "Check-box"
          } ]
        }
      } ],
      "answerOption": [ {
        "valueCoding": {
          "display": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient."
        }
      } ]
    } ],
    "text": "Supporting Documentation Header",
    "type": "group",
    "_text": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
        "valueString": "
Supporting Documentation
Please attach all relevant laboratory and diagnostic investigations.
"
      } ]
    },
    "linkId": "supportingdocumentation_header"
  }, {
    "text": "Add Attachments",
    "type": "attachment",
    "linkId": "supportingdocumentation_attachment",
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "application/pdf"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "image/bmp"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "video/mp4"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "text/csv"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "image/jpeg"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "application/msword"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "image/png"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
      "valueCode": "application/vnd.ms-excel"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
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