{
  "description": null,
  "_filename": "example/Questionnaire-order-referral-form-modular.json",
  "package_name": "ch.fhir.ig.ch-orf",
  "subjectType": [ "Patient" ],
  "date": "2022-07-07",
  "meta": {
    "profile": [ "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-questionnaire", "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire", "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap", "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-pop-exp" ]
  },
  "publisher": "HL7 Switzerland",
  "jurisdiction": [ {
    "coding": [ {
      "code": "CH",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "OrderReferralForm",
  "item": [ {
    "item": [ {
      "text": "Unable to resolve 'order' sub-questionnaire",
      "type": "display",
      "linkId": "order.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-order|1.1.0"
      } ]
    } ],
    "text": "Auftrag",
    "type": "group",
    "linkId": "order",
    "required": true
  }, {
    "item": [ {
      "text": "Unable to resolve 'receiver' sub-questionnaire",
      "type": "display",
      "linkId": "receiver.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-receiver|1.1.0"
      } ]
    } ],
    "text": "Empfänger",
    "type": "group",
    "linkId": "receiver",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:receiver"
  }, {
    "item": [ {
      "text": "Unable to resolve 'intitiator' sub-questionnaire",
      "type": "display",
      "linkId": "initiator.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-initiator|1.1.0"
      } ]
    } ],
    "text": "Initiant dieser Anmeldung",
    "type": "group",
    "linkId": "initiator",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension"
  }, {
    "item": [ {
      "text": "Unable to resolve 'patient' sub-questionnaire",
      "type": "display",
      "linkId": "patient.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-patient|1.1.0"
      } ]
    } ],
    "text": "Patient",
    "type": "group",
    "linkId": "patient",
    "required": true,
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/variable",
      "valueExpression": {
        "name": "linkIdPrefix",
        "language": "text/fhirpath",
        "expression": "'patient.'"
      }
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/variable",
      "valueExpression": {
        "name": "address",
        "language": "text/fhirpath",
        "expression": "%patient.address"
      }
    } ],
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.subject"
  }, {
    "item": [ {
      "text": "Unable to resolve 'requestedEncounter' sub-questionnaire",
      "type": "display",
      "linkId": "requestedEncounter.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-requestedencounter|1.1.0"
      } ]
    } ],
    "text": "Patientenaufnahme",
    "type": "group",
    "linkId": "requestedEncounter",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.extension:requestedEncounterDetails"
  }, {
    "item": [ {
      "text": "Unable to resolve 'coverage' sub-questionnaire",
      "type": "display",
      "linkId": "coverage.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-coverage|1.1.0"
      } ]
    } ],
    "text": "Kostenträger",
    "type": "group",
    "linkId": "coverage",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.insurance"
  }, {
    "item": [ {
      "text": "Unable to resolve 'sender' sub-questionnaire",
      "type": "display",
      "linkId": "sender.1",
      "required": true,
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-sender|1.1.0"
      } ],
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.author"
    } ],
    "text": "Absender",
    "type": "group",
    "linkId": "sender",
    "required": true
  }, {
    "item": [ {
      "text": "Unable to resolve 'receiverCopy' sub-questionnaire",
      "type": "display",
      "linkId": "receiverCopy.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-receivercopy|1.1.0"
      } ]
    } ],
    "text": "Kopieempfänger (Kopie dieses Auftrags und aller daraus resultierenden Resultate)",
    "type": "group",
    "linkId": "receiverCopy",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:copyReceiver"
  }, {
    "item": [ {
      "text": "Von",
      "type": "dateTime",
      "linkId": "antecedentEpisodeOfCare.start",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-episodeofcare#EpisodeOfCare.Period.end"
    }, {
      "text": "Bis",
      "type": "dateTime",
      "linkId": "antecedentEpisodeOfCare.end",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-episodeofcare#EpisodeOfCare.Period.end"
    }, {
      "item": [ {
        "text": "Name der Organisation",
        "type": "string",
        "linkId": "antecedentEpisodeOfCare.managingOrganization.name",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.name"
      }, {
        "text": "Unable to resolve 'address' sub-questionnaire",
        "type": "display",
        "linkId": "antecedentEpisodeOfCare.managingOrganization.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
          "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-address|1.1.0"
        } ]
      } ],
      "text": "Spital /Heim",
      "type": "group",
      "linkId": "antecedentEpisodeOfCare.managingOrganization",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/variable",
        "valueExpression": {
          "name": "linkIdPrefix",
          "language": "text/fhirpath",
          "expression": "'antecedentEpisodeOfCare.managingOrganization.'"
        }
      } ],
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-episodeofcare#EpisodeOfCare.managingOrganization"
    } ],
    "text": "Vorgängiger Aufenthalt in Spital / Heim",
    "type": "group",
    "linkId": "antecedentEpisodeOfCare",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:antecedentEpisodeOfCare"
  }, {
    "item": [ {
      "text": "Unable to resolve 'appointment' sub-questionnaire",
      "type": "display",
      "linkId": "appointment.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-appointment|1.1.0"
      } ]
    } ],
    "text": "Ort und Zeit der Durchführung der angeforderten Leistung",
    "type": "group",
    "linkId": "appointment",
    "repeats": true,
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.extension:locationAndTime"
  }, {
    "item": [ {
      "text": "Unable to resolve 'consent' sub-questionnaire",
      "type": "display",
      "linkId": "consent.1",
      "extension": [ {
        "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
        "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-consent|1.1.0"
      } ]
    } ],
    "text": "Einverständniserklärung",
    "type": "group",
    "linkId": "consent",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:patientConsent"
  }, {
    "item": [ {
      "text": "Kommentar",
      "type": "string",
      "linkId": "note.text",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.note.text"
    } ],
    "text": "Bemerkungen",
    "type": "group",
    "linkId": "note",
    "repeats": true
  } ],
  "copyright": "CC0-1.0",
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Order Referral Form",
  "package_version": "2.0.1",
  "extension": [ {
    "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-assemble-expectation",
    "valueCode": "assemble-root"
  }, {
    "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
    "valueCanonical": "http://fhir.ch/ig/ch-orf/StructureMap/OrfQrToBundle"
  }, {
    "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext",
    "extension": [ {
      "url": "name",
      "valueCoding": {
        "code": "patient",
        "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext"
      }
    }, {
      "url": "type",
      "valueCode": "Patient"
    } ]
  }, {
    "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext",
    "extension": [ {
      "url": "name",
      "valueCoding": {
        "code": "user",
        "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
        "display": "User"
      }
    }, {
      "url": "type",
      "valueCode": "Practitioner"
    }, {
      "url": "description",
      "valueString": "The practitioner that is to be used to pre-populate the form"
    } ]
  } ],
  "status": "active",
  "language": "de-CH",
  "id": "d35f5521-aa71-42f2-80eb-d139bb55d1af",
  "kind": null,
  "url": "http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form-modular",
  "version": "2.0.1",
  "contact": [ {
    "name": "HL7 Switzerland",
    "telecom": [ {
      "value": "https://www.hl7.ch/",
      "system": "url"
    } ]
  } ]
}