{
"description": "A form to be used in conjunction with patient registration workflows",
"_filename": "examples/Questionnaire-Patient-Registration.json",
"package_name": "uk.nhsdigital.r4.test",
"subjectType": [ "Patient" ],
"date": null,
"publisher": null,
"name": "PatientRegistration",
"item": [ {
"text": "Title",
"type": "string",
"linkId": "prefix",
"required": true
}, {
"text": "First Name",
"type": "string",
"linkId": "forename",
"required": true
}, {
"text": "Middle Name(s)",
"type": "string",
"linkId": "middlenames",
"required": false
}, {
"text": "Last name",
"type": "string",
"linkId": "surname",
"required": true
}, {
"text": "Previous last name",
"type": "string",
"linkId": "previous_surname"
}, {
"text": "Date of Birth",
"type": "date",
"linkId": "date_of_birth",
"required": true
}, {
"text": "NHS Number (if known)",
"type": "string",
"linkId": "nhs_number",
"maxLength": 10
}, {
"text": "Your postcode used when you last registered with a UK GP",
"type": "string",
"linkId": "previous_postcode"
}, {
"text": "Your current address",
"type": "string",
"linkId": "current_address"
}, {
"item": [ {
"text": "Contact Type",
"type": "choice",
"linkId": "contact_type",
"required": false,
"answerValueSet": "http://hl7.org/fhir/ValueSet/contact-point-system"
}, {
"text": "Contact Number or email",
"type": "string",
"linkId": "contact_value"
} ],
"text": "Contact Preference",
"type": "group",
"linkId": "contact_group",
"repeats": true
}, {
"text": "Gender assigned at Birth",
"type": "choice",
"linkId": "gender_birth",
"answerOption": [ {
"valueCoding": {
"code": "female",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Female"
}
}, {
"valueCoding": {
"code": "male",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Male"
}
}, {
"valueCoding": {
"code": "other",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Non Binary"
}
}, {
"valueCoding": {
"code": "unknown",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Prefer to self describe"
}
} ]
}, {
"text": "Ethnic Category",
"type": "choice",
"linkId": "ethnic",
"required": false,
"answerValueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-DeathNotificationStatus"
}, {
"text": "Have you ever been a member of the UK Armed Forces or are a family member registered with the Defence Medical Services?",
"type": "boolean",
"linkId": "armed_forces"
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "Patient Registration",
"package_version": "2.18.10-prerelease",
"status": "draft",
"id": "d0ca76cb-481e-466a-b36c-a467300b9cf2",
"kind": null,
"url": "https://example.nhs.uk/Questionnaire/Patient-Registration",
"version": null
}