{
  "description": null,
  "_filename": "example/Questionnaire-order-referral-form.json",
  "package_name": "ch.fhir.ig.ch-orf",
  "subjectType": [ "Patient" ],
  "date": "2021-03-26",
  "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-extract", "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-populate" ]
  },
  "publisher": "HL7 Switzerland",
  "jurisdiction": [ {
    "coding": [ {
      "code": "CH",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "OrderReferralForm",
  "item": [ {
    "item": [ {
      "text": "Titel",
      "type": "string",
      "linkId": "order.title",
      "readOnly": true,
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.title"
    }, {
      "text": "Typ",
      "type": "choice",
      "linkId": "order.type",
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.type",
      "answerValueSet": "http://fhir.ch/ig/ch-epr-term/ValueSet/DocumentEntry.typeCode"
    }, {
      "text": "Kategorie",
      "type": "choice",
      "linkId": "order.category",
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.category",
      "answerValueSet": "http://fhir.ch/ig/ch-epr-term/ValueSet/DocumentEntry.classCode"
    }, {
      "text": "Auftragsnummer des Auftraggebers",
      "type": "string",
      "linkId": "order.placerOrderIdentifier",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.identifier:placerOrderIdentifier.value"
    }, {
      "text": "Identifier Domain der Auftragsnummer des Auftraggebers",
      "type": "string",
      "linkId": "order.placerOrderIdentifierDomain",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
        "valueBoolean": true
      } ],
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.identifier:placerOrderIdentifier.system"
    }, {
      "text": "Auftragsnummer des Auftragsempfängers",
      "type": "string",
      "linkId": "order.fillerOrderIdentifier",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.identifier:fillerOrderIdentifier.value"
    }, {
      "text": "Identifier Domain der Auftragsnummer des Auftragsempfängers",
      "type": "string",
      "linkId": "order.fillerOrderIdentifierDomain",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
        "valueBoolean": true
      } ],
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.identifier:fillerOrderIdentifier.system"
    }, {
      "text": "Identifier des Vorgängerdokuments",
      "type": "string",
      "linkId": "order.precedentDocumentIdentifier",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
        "valueBoolean": true
      } ],
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:precedentDocument"
    }, {
      "item": [ {
        "item": [ {
          "text": "Titel",
          "type": "string",
          "linkId": "order.notificationContactDocument.practitioner.title",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.prefix"
        }, {
          "text": "Name",
          "type": "string",
          "linkId": "order.notificationContactDocument.practitioner.familyName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.family"
        }, {
          "text": "Vorname",
          "type": "string",
          "linkId": "order.notificationContactDocument.practitioner.givenName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.given"
        }, {
          "text": "Telefon",
          "type": "string",
          "linkId": "order.notificationContactDocument.practitioner.phone",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        }, {
          "text": "E-Mail",
          "type": "string",
          "linkId": "order.notificationContactDocument.practitioner.email",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        } ],
        "text": "Zu benachrichtigende Person",
        "type": "group",
        "linkId": "order.notificationContactDocument.practitioner",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.practitioner"
      } ],
      "text": "Dringender Benachrichtigungskontakt für dieses Dokument",
      "type": "group",
      "linkId": "order.notificationContactDocument",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:urgentNoficationContactForThisDocument"
    }, {
      "item": [ {
        "item": [ {
          "text": "Titel",
          "type": "string",
          "linkId": "order.notificationContactDocumentResponse.practitioner.title",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.prefix"
        }, {
          "text": "Name",
          "type": "string",
          "linkId": "order.notificationContactDocumentResponse.practitioner.familyName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.family"
        }, {
          "text": "Vorname",
          "type": "string",
          "linkId": "order.notificationContactDocumentResponse.practitioner.givenName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.given"
        }, {
          "text": "Telefon",
          "type": "string",
          "linkId": "order.notificationContactDocumentResponse.practitioner.phone",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        }, {
          "text": "E-Mail",
          "type": "string",
          "linkId": "order.notificationContactDocumentResponse.practitioner.email",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        } ],
        "text": "Zu benachrichtigende Person",
        "type": "group",
        "linkId": "order.notificationContactDocumentResponse.practitioner",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.practitioner"
      } ],
      "text": "Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument",
      "type": "group",
      "linkId": "order.notificationContactDocumentResponse",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:urgentNoficationContactForTheResponseToThisDocument"
    }, {
      "text": "Auftragspriorität",
      "type": "choice",
      "linkId": "order.priority",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.priority",
      "answerOption": [ {
        "valueCoding": {
          "code": "routine",
          "system": "http://hl7.org/fhir/request-priority",
          "display": "Die Anfrage hat normale Priorität."
        },
        "initialSelected": true
      }, {
        "valueCoding": {
          "code": "urgent",
          "system": "http://hl7.org/fhir/request-priority",
          "display": "Die Anfrage sollte dringend bearbeitet werden - höhere Priorität als normal."
        }
      }, {
        "valueCoding": {
          "code": "asap",
          "system": "http://hl7.org/fhir/request-priority",
          "display": "Die Anfrage sollte so schnell wie möglich bearbeitet werden - höhere Priorität als dringend."
        }
      }, {
        "valueCoding": {
          "code": "stat",
          "system": "http://hl7.org/fhir/request-priority",
          "display": "Die Anfrage sollte sofort bearbeitet werden - höchstmögliche Priorität. Z.B. bei einem Notfall."
        }
      } ]
    } ],
    "text": "Auftrag",
    "type": "group",
    "linkId": "order",
    "required": true,
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-document#Bundle"
  }, {
    "item": [ {
      "item": [ {
        "text": "Titel",
        "type": "string",
        "linkId": "receiver.practitioner.title",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.prefix"
      }, {
        "text": "Name",
        "type": "string",
        "linkId": "receiver.practitioner.familyName",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.family"
      }, {
        "text": "Vorname",
        "type": "string",
        "linkId": "receiver.practitioner.givenName",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.given"
      }, {
        "text": "GLN",
        "type": "string",
        "linkId": "receiver.practitioner.gln",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.identifier:GLN.value"
      }, {
        "text": "Telefon",
        "type": "string",
        "linkId": "receiver.practitioner.phone",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
      }, {
        "text": "E-Mail",
        "type": "string",
        "linkId": "receiver.practitioner.email",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
      } ],
      "text": "Empfangende Person",
      "type": "group",
      "linkId": "receiver.practitioner",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.practitioner"
    }, {
      "item": [ {
        "text": "Name der Organisation",
        "type": "string",
        "linkId": "receiver.organization.name",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.name"
      }, {
        "text": "Strasse, Hausnummer, Postfach etc.",
        "type": "string",
        "linkId": "receiver.organization.streetAddressLine",
        "repeats": true,
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.line"
      }, {
        "text": "PLZ",
        "type": "string",
        "linkId": "receiver.organization.postalCode",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.postalCode"
      }, {
        "text": "Ort",
        "type": "string",
        "linkId": "receiver.organization.city",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.city"
      }, {
        "text": "Land",
        "type": "string",
        "linkId": "receiver.organization.country",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.country"
      } ],
      "text": "Empfangende Organisation",
      "type": "group",
      "linkId": "receiver.organization",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.organization"
    } ],
    "text": "Empfänger",
    "type": "group",
    "linkId": "receiver",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:receiver"
  }, {
    "item": [ {
      "text": "Name",
      "type": "string",
      "linkId": "patient.familyName",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.name.family"
    }, {
      "text": "Ledigname",
      "type": "string",
      "linkId": "patient.maidenName",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.name.family"
    }, {
      "text": "Vorname",
      "type": "string",
      "linkId": "patient.givenName",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.name.given"
    }, {
      "text": "Lokale Patienten-ID",
      "type": "string",
      "linkId": "patient.localPid",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.identifier:LocalPid.value"
    }, {
      "text": "Lokale Patienten-ID Domain",
      "type": "string",
      "linkId": "patient.localPidDomain",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
        "valueBoolean": true
      } ],
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.identifier:LocalPid.system"
    }, {
      "text": "Geburtsdatum",
      "type": "date",
      "linkId": "patient.birthDate",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.birthDate"
    }, {
      "text": "Geschlecht",
      "type": "choice",
      "linkId": "patient.gender",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.gender",
      "answerOption": [ {
        "valueCoding": {
          "code": "male",
          "system": "http://hl7.org/fhir/administrative-gender",
          "display": "Männlich"
        },
        "initialSelected": true
      }, {
        "valueCoding": {
          "code": "female",
          "system": "http://hl7.org/fhir/administrative-gender",
          "display": "Weiblich"
        }
      }, {
        "valueCoding": {
          "code": "other",
          "system": "http://hl7.org/fhir/administrative-gender",
          "display": "Anderes"
        }
      } ]
    }, {
      "text": "Telefon",
      "type": "string",
      "linkId": "patient.phone",
      "repeats": true,
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.telecom.value"
    }, {
      "text": "E-Mail",
      "type": "string",
      "linkId": "patient.email",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.telecom.value"
    }, {
      "text": "Strasse, Hausnummer, Postfach etc.",
      "type": "string",
      "linkId": "patient.streetAddressLine",
      "repeats": true,
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.address.line"
    }, {
      "text": "PLZ",
      "type": "string",
      "linkId": "patient.postalCode",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.address.postalCode"
    }, {
      "text": "Ort",
      "type": "string",
      "linkId": "patient.city",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.address.city"
    }, {
      "text": "Land",
      "type": "string",
      "linkId": "patient.country",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.address.country"
    }, {
      "item": [ {
        "text": "Beziehung",
        "type": "string",
        "linkId": "patient.contactperson.relationship",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.contact.relationship.text"
      }, {
        "text": "Name",
        "type": "string",
        "linkId": "patient.contactperson.familyName",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.contact.name.family"
      }, {
        "text": "Vorname",
        "type": "string",
        "linkId": "patient.contactperson.givenName",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.contact.name.given"
      }, {
        "text": "Telefon",
        "type": "string",
        "linkId": "patient.contactperson.phone",
        "repeats": true,
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.contact.telecom.value"
      }, {
        "text": "E-Mail",
        "type": "string",
        "linkId": "patient.contactperson.email",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.contact.telecom.value"
      } ],
      "text": "Kontaktperson",
      "type": "group",
      "linkId": "patient.contactperson",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.contact"
    } ],
    "text": "Patient",
    "type": "group",
    "linkId": "patient",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.subject"
  }, {
    "item": [ {
      "text": "Voraussichtlich: Ambulant / Stationär / Notfall",
      "type": "choice",
      "linkId": "requestedEncounter.class",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-encounter#Encounter.class",
      "answerOption": [ {
        "valueCoding": {
          "code": "AMB",
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "display": "Ambulant"
        }
      }, {
        "valueCoding": {
          "code": "IMP",
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "display": "Stationär"
        }
      }, {
        "valueCoding": {
          "code": "EMER",
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "display": "Notfall"
        }
      } ]
    }, {
      "text": "Zimmerkategorie",
      "type": "choice",
      "linkId": "requestedEncounter.desiredAccommodation",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-encounter#Encounter.extension:desiredAccommodation",
      "answerOption": [ {
        "valueCoding": {
          "code": "P",
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "display": "Einerzimmer"
        }
      }, {
        "valueCoding": {
          "code": "SP",
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "display": "Zweierzimmer"
        }
      }, {
        "valueCoding": {
          "code": "W",
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "display": "Mehrbettzimmer"
        }
      } ]
    } ],
    "text": "Patientenaufnahme",
    "type": "group",
    "linkId": "requestedEncounter",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.extension:requestedEncounterDetails"
  }, {
    "item": [ {
      "item": [ {
        "text": "AHV-Nr. des Patienten",
        "type": "string",
        "linkId": "coverage.beneficiary.ahvn13",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.identifier:AHVN13"
      } ],
      "text": "Begünstigter (Patient)",
      "type": "group",
      "linkId": "coverage.beneficiary",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.beneficiary"
    }, {
      "item": [ {
        "text": "Name der Versicherung",
        "type": "string",
        "linkId": "coverage.kvg.name",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
      }, {
        "text": "Kennnummer der Versichertenkarte",
        "type": "string",
        "linkId": "coverage.kvg.insuranceCardNumber",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
      } ],
      "text": "Krankenkasse (nach KVG)",
      "type": "group",
      "linkId": "coverage.kvg",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    }, {
      "item": [ {
        "text": "Name der Versicherung",
        "type": "string",
        "linkId": "coverage.uvg.name",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
      }, {
        "text": "Schadennummer",
        "type": "string",
        "linkId": "coverage.uvg.claimNumber",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
      } ],
      "text": "Unfallversicherung (nach UVG)",
      "type": "group",
      "linkId": "coverage.uvg",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    }, {
      "item": [ {
        "text": "Name der Versicherung",
        "type": "string",
        "linkId": "coverage.vvg.name",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
      }, {
        "text": "Kennnummer der Versichertenkarte",
        "type": "string",
        "linkId": "coverage.vvg.insuranceCardNumber",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
      } ],
      "text": "Zusatzversicherung (nach VVG)",
      "type": "group",
      "linkId": "coverage.vvg",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    }, {
      "item": [ {
        "text": "IV-Verfügungsnummer",
        "type": "string",
        "linkId": "coverage.iv.verfuegungsnummer",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
      } ],
      "text": "Invalidenversicherung (IV)",
      "type": "group",
      "linkId": "coverage.iv",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    }, {
      "item": [ {
        "text": "MV-Versichertennummer",
        "type": "string",
        "linkId": "coverage.mv.versichertennummer",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
      } ],
      "text": "Militärversicherung (MV)",
      "type": "group",
      "linkId": "coverage.mv",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    }, {
      "item": [ {
        "text": "Name",
        "type": "string",
        "linkId": "coverage.self.familyName",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
      }, {
        "text": "Vorname",
        "type": "string",
        "linkId": "coverage.self.givenName",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
      } ],
      "text": "Selbstzahler",
      "type": "group",
      "linkId": "coverage.self",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    }, {
      "item": [ {
        "text": "Name des Kostenträgers",
        "type": "string",
        "linkId": "coverage.other.name",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
      }, {
        "text": "Beliebige ID",
        "type": "string",
        "linkId": "coverage.other.id",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
      }, {
        "text": "Bemerkung zur ID",
        "type": "string",
        "linkId": "coverage.other.id.note",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier.type.text"
      } ],
      "text": "Anderer Kostenträger",
      "type": "group",
      "linkId": "coverage.other",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
    } ],
    "text": "Kostenträger",
    "type": "group",
    "linkId": "coverage",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.insurance"
  }, {
    "item": [ {
      "item": [ {
        "item": [ {
          "text": "Titel",
          "type": "string",
          "linkId": "sender.author.practitioner.title",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.prefix"
        }, {
          "text": "Name",
          "type": "string",
          "linkId": "sender.author.practitioner.familyName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.family"
        }, {
          "text": "Vorname",
          "type": "string",
          "linkId": "sender.author.practitioner.givenName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.given"
        }, {
          "text": "GLN",
          "type": "string",
          "linkId": "sender.author.practitioner.gln",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.identifier:GLN.value"
        }, {
          "text": "Telefon",
          "type": "string",
          "linkId": "sender.author.practitioner.phone",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        }, {
          "text": "E-Mail",
          "type": "string",
          "linkId": "sender.author.practitioner.email",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        } ],
        "text": "Verantwortliche Person",
        "type": "group",
        "linkId": "sender.author.practitioner",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.practitioner"
      }, {
        "item": [ {
          "text": "Name der Organisation",
          "type": "string",
          "linkId": "sender.author.organization.name",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.name"
        }, {
          "text": "Strasse, Hausnummer, Postfach etc.",
          "type": "string",
          "linkId": "sender.author.organization.streetAddressLine",
          "repeats": true,
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.line"
        }, {
          "text": "PLZ",
          "type": "string",
          "linkId": "sender.author.organization.postalCode",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.postalCode"
        }, {
          "text": "Ort",
          "type": "string",
          "linkId": "sender.author.organization.city",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.city"
        }, {
          "text": "Land",
          "type": "string",
          "linkId": "sender.author.organization.country",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.address.country"
        } ],
        "text": "Verantwortliche Organisation",
        "type": "group",
        "linkId": "sender.author.organization",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.organization"
      } ],
      "text": "Verantwortlicher",
      "type": "group",
      "linkId": "sender.author",
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.author"
    }, {
      "item": [ {
        "item": [ {
          "text": "Name",
          "type": "string",
          "linkId": "sender.dataenterer.practitioner.familyName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.family"
        }, {
          "text": "Vorname",
          "type": "string",
          "linkId": "sender.dataenterer.practitioner.givenName",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.name.given"
        }, {
          "text": "Telefon",
          "type": "string",
          "linkId": "sender.dataenterer.practitioner.phone",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        }, {
          "text": "E-Mail",
          "type": "string",
          "linkId": "sender.dataenterer.practitioner.email",
          "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitioner#Practitioner.telecom.value"
        } ],
        "text": "Erfassende Person",
        "type": "group",
        "linkId": "sender.dataenterer.practitioner",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-practitionerrole#PractitionerRole.practitioner"
      } ],
      "text": "Erfasser",
      "type": "group",
      "linkId": "sender.dataenterer",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:dataEnterer"
    } ],
    "text": "Absender",
    "type": "group",
    "linkId": "sender",
    "required": true
  }, {
    "item": [ {
      "item": [ {
        "text": "Name der Organisation",
        "type": "string",
        "linkId": "receiverCopy.organization.name",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-organization#Organization.name"
      }, {
        "text": "Titel",
        "type": "string",
        "linkId": "receiverCopy.title",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-humanname#HumanName.prefix"
      }, {
        "text": "Name",
        "type": "string",
        "linkId": "receiverCopy.familyName",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-humanname#HumanName.family"
      }, {
        "text": "Vorname",
        "type": "string",
        "linkId": "receiverCopy.givenName",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-humanname#HumanName.given"
      }, {
        "text": "Telefon",
        "type": "string",
        "linkId": "receiverCopy.phone",
        "definition": "http://hl7.org/fhir/StructureDefinition/ContactPoint#ContactPoint.value"
      }, {
        "text": "E-Mail",
        "type": "string",
        "linkId": "receiverCopy.email",
        "definition": "http://hl7.org/fhir/StructureDefinition/ContactPoint#ContactPoint.value"
      }, {
        "text": "Strasse, Hausnummer, Postfach etc.",
        "type": "string",
        "linkId": "receiverCopy.streetAddressLine",
        "repeats": true,
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-address#Address.line"
      }, {
        "text": "PLZ",
        "type": "string",
        "linkId": "receiverCopy.postalCode",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-address#Address.postalCode"
      }, {
        "text": "Ort",
        "type": "string",
        "linkId": "receiverCopy.city",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-address#Address.city"
      }, {
        "text": "Land",
        "type": "string",
        "linkId": "receiverCopy.country",
        "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-address#Address.country"
      } ],
      "text": "Kopieempfangende Organisation oder Person",
      "type": "group",
      "linkId": "receiverCopy",
      "repeats": true
    } ],
    "text": "Kopieempfänger",
    "type": "group",
    "linkId": "receiverCopies",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-composition#Composition.extension:copyReceiver"
  }, {
    "item": [ {
      "item": [ {
        "text": "Name",
        "type": "string",
        "linkId": "appointment.location.name",
        "required": true,
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.name"
      }, {
        "text": "Telefon",
        "type": "string",
        "linkId": "appointment.location.phone",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.telecom.value"
      }, {
        "text": "E-Mail",
        "type": "string",
        "linkId": "appointment.location.email",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.telecom.value"
      }, {
        "text": "Strasse, Hausnummer, Postfach etc.",
        "type": "string",
        "linkId": "appointment.location.streetAddressLine",
        "repeats": true,
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.address.line"
      }, {
        "text": "PLZ",
        "type": "string",
        "linkId": "appointment.location.postalCode",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.address.postalCode"
      }, {
        "text": "Ort",
        "type": "string",
        "linkId": "appointment.location.city",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.address.city"
      }, {
        "text": "Land",
        "type": "string",
        "linkId": "appointment.location.country",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-location#Location.address.country"
      } ],
      "text": "Ort der Durchführung",
      "type": "group",
      "linkId": "appointment.location",
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-appointment#Appointment.participant.actor"
    }, {
      "item": [ {
        "text": "Von",
        "type": "dateTime",
        "linkId": "appointment.requestedPeriod.start",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-appointment#Appointment.requestedPeriod.start"
      }, {
        "text": "Bis",
        "type": "dateTime",
        "linkId": "appointment.requestedPeriod.end",
        "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-appointment#Appointment.requestedPeriod.end"
      } ],
      "text": "Datum und Zeit, wann der Termin bevorzugt geplant werden soll",
      "type": "group",
      "linkId": "appointment.requestedPeriod",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-appointment#Appointment.requestedPeriod"
    }, {
      "text": "Status",
      "type": "choice",
      "linkId": "appointment.status",
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-appointment#Appointment.status",
      "answerOption": [ {
        "valueCoding": {
          "code": "proposed",
          "system": "http://hl7.org/fhir/appointmentstatus",
          "display": "Wunsch des Patienten (vorgeschlagen)"
        },
        "initialSelected": true
      }, {
        "valueCoding": {
          "code": "pending",
          "system": "http://hl7.org/fhir/appointmentstatus",
          "display": "Vom Patienten bestätigt, aber vom Leistungserbringer noch nicht (ausstehend)"
        }
      }, {
        "valueCoding": {
          "code": "booked",
          "system": "http://hl7.org/fhir/appointmentstatus",
          "display": "Vom Patienten und Leistungserbringer bestätigt (gebucht)"
        }
      } ]
    }, {
      "text": "Patienteninformation für diesen Termin",
      "type": "string",
      "linkId": "appointment.patientInstruction",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-appointment#Appointment.patientInstruction"
    } ],
    "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": "Kommentar",
      "type": "string",
      "linkId": "note.text",
      "required": true,
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-servicerequest#ServiceRequest.note.text"
    } ],
    "text": "Bemerkungen",
    "type": "group",
    "linkId": "note",
    "repeats": true
  } ],
  "copyright": "CC-BY-SA-4.0",
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Order-Referral-Form",
  "package_version": "0.10.0",
  "extension": [ {
    "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-sourceStructureMap",
    "valueCanonical": "http://fhir.ch/ig/ch-orf/StructureMap/OrfPrepopBundleToQr"
  }, {
    "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext",
    "extension": [ {
      "url": "name",
      "valueId": "Bundle"
    }, {
      "url": "type",
      "valueCode": "Bundle"
    }, {
      "url": "description",
      "valueString": "The Bundle that is to be used to pre-populate the form"
    } ]
  } ],
  "status": "active",
  "id": "fe205dfe-1ae7-43fd-bcd6-ec9871499a7a",
  "kind": null,
  "url": "http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form",
  "version": "0.10.0",
  "contact": [ {
    "name": "HL7 Switzerland",
    "telecom": [ {
      "value": "https://www.hl7.ch/",
      "system": "url"
    } ]
  } ]
}