{
  "description": "Sample questionnaire using all questions from the admission clinical summary questionnaire",
  "_filename": "examples/ClinicalSummary-Questionnaire-Template.json",
  "package_name": "ca.on.oh.mha.pds",
  "date": null,
  "publisher": null,
  "purpose": "To serve as a model to support MHA admission questionnaires.",
  "name": null,
  "item": [ {
    "text": "Symptoms of Clinical Concern",
    "type": "choice",
    "linkId": "Q1",
    "repeats": true,
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/mha-presenting-concerns"
  }, {
    "text": "Behavioural Addictions and/or Problematic Substance Use",
    "type": "choice",
    "linkId": "Q2",
    "repeats": true,
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/mha-behavioural-addictions-problematic-substance-use"
  }, {
    "text": "Other Reasons for Seeking Service",
    "type": "choice",
    "linkId": "Q3",
    "repeats": true,
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/mha-reasons-for-seeking-advice"
  }, {
    "item": [ {
      "text": "Are you receiving prescribed pharmacotherapy or anti-craving medication for alcohol use disorder?",
      "type": "choice",
      "linkId": "Q4-a",
      "answerOption": [ {
        "valueString": "Yes"
      }, {
        "valueString": "No"
      }, {
        "valueString": "Asked but declined"
      } ]
    }, {
      "text": "What anti-craving medication prescribed?",
      "type": "choice",
      "linkId": "Q4-b",
      "repeats": true,
      "enableWhen": [ {
        "operator": "=",
        "question": "Q3-a",
        "answerString": "Yes"
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/mha-anti-craving-medication"
    } ],
    "text": "Prescribed pharmacotherapy or anti-craving medication for alcohol use disorder",
    "type": "group",
    "linkId": "Q4"
  }, {
    "item": [ {
      "text": "Are you receiving prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder?",
      "type": "choice",
      "linkId": "Q5-a",
      "answerOption": [ {
        "valueString": "Yes"
      }, {
        "valueString": "No"
      }, {
        "valueString": "Asked but declined"
      } ]
    }, {
      "text": "What opioid Agonist therapy is prescribed?",
      "type": "choice",
      "linkId": "Q5-b",
      "enableWhen": [ {
        "operator": "=",
        "question": "Q4-a",
        "answerString": "Yes"
      } ],
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/opioid-agonist-medication"
    } ],
    "text": "Prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder",
    "type": "group",
    "linkId": "Q5"
  }, {
    "text": "Gambing Problem Identified",
    "type": "choice",
    "linkId": "Q6",
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-problem-identified"
  }, {
    "text": "Reason for Non-completion of Gambling Data Form",
    "type": "choice",
    "linkId": "Q7",
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/mha-gambling-data-form-non-completion-reason"
  }, {
    "text": "Gambling Treatment Plan Status",
    "type": "choice",
    "linkId": "Q8",
    "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-treatment-plan-status"
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "MHA Clinical Summary Questionnaire Template",
  "package_version": "2.0.0-alpha-preview",
  "status": "draft",
  "id": "e7ef96d9-b5f9-43f7-be08-a32ca323498e",
  "kind": null,
  "url": "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-clinical-summary-questionnaire-template",
  "version": null
}