Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.4 - release

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.4) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Questionnaire: Private Colposcopy Referral Summary Questionnaire

Official URL: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PrivateColposcopyReferralQuestionnaire | Version: 0.1.1
Draft as of 2025-12-11 | Computable Name: PrivateColposcopyReferralQuestionnaire
Other Identifiers: PrivateColposcopyReferralQuestionnaire (use: official, )
Usage:Workflow Setting:

To gather the referral details of Private colposcopy procedure.

Structure

LinkID | Text | Cardinality | Type | Description & Constraints
--- | --- | --- | --- | ---
PrivateColposcopyReferralQuestionnaire |  |  | Questionnaire | https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PrivateColposcopyReferralQuestionnaire#0.1.1
p01-ClinicInformation | page 01. Clinic Information | 0..1 | group |
p01-q01-FacilityID | page 01 question 1. Colposcopy HPI facility ID | 1..1 | reference |
p02-ReferralInformation | page 02. Referral Information | 0..1 | group |
p02-q01-SelfReferral | page 02 question 1. Self Referral? | 1..1 | boolean |
p02-q02.1-SelfReferral | page 02 question 2.1. If your patient has self-referred enter in their GP’s HPI-CPN and HPI Health Facility ID | 0..1 | display |
p02-q02-ReferredByName | page 02 question 2. Referred by health worker name | 1..1 | reference |
p02-q03-ReferredByFacilityID | page 02 question 3. Referred by health facility ID | 1..1 | reference |
p02-q04-ReferralDateReceived | page 02 question 5. Referral received date | 0..1 | date |
p02-q05-ReferralDateAccepted | page 02 question 6. Referral accepted date | 1..1 | date |
p02-q06-AppointmentDate | page 02 question 7. Appointment date | 0..1 | date |
p02-q07-FirstVisit | page 02 question 8. First colposcopy visit? | 1..1 | boolean |
p02-q8-FollowUpType | page 02 question 9. Follow-up Colposcopy Visit | 1..1 | choice | Enable When: p02-q07-FirstVisit = Options: 4 options
p02-q9-FollowUpTimeFrame | page 02 question 9. Follow-up timeframe | 1..1 | choice | Enable When: p02-q07-FirstVisit = Options: 15 options
p03-RefferalReason | page 03. Reason for Referral | 1..1 | group |
p03-q01-AssessmentReason | page 03 question 1. Assessment for the reason for referral | 1..1 | choice | Options: 12 options
p03-q02-OtherReason | page 03 question 2. Other Reason (if Any) | 0..1 | string | Enable When: p03-q01-AssessmentReason =
Documentation for this format

Options Sets

Answer options for p02-q8-FollowUpType

- null#null ("1st Follow Up Visit")
- null#null ("2nd Follow Up Visit")
- null#null ("3rd Follow Up Visit")
- null#null ("4th or more Follow up Visit")

Answer options for p02-q9-FollowUpTimeFrame

- null#7D ("7 Days")
- null#2W ("2 Weeks")
- null#6W ("6 Weeks")
- null#1M ("1 Month")
- null#2M ("2 Months")
- null#3M ("3 Months")
- null#4M ("4 Months")
- null#5M ("5 Months")
- null#6M ("6 Months")
- null#7M ("7 Months")
- null#9M ("9 Months")
- null#12M ("12 Months")
- null#18M ("18 Months")
- null#36M ("36 Months")
- null#60M ("60 Months")

Answer options for p03-q01-AssessmentReason

- null#null ("Any cytological evidence or suspicion of invasion")
- null#null ("Any cytological glandular abnormality")
- null#null ("HPV 16/18 with or without cytology")
- null#null ("HPV other where the participant is immune compromised")
- null#null ("HPV other with LSIL on two occasions if over 50 and 3 occasions if under 50")
- null#null ("Positive test of cure")
- null#null ("Low-grade clinical assessment")
- null#null ("High-grade clinical assessment")
- null#null ("Suspicion of an invasive cancer clinical assessment")
- null#null ("HPV not detected with high-grade cytology")
- null#null ("HPV not detected with suspicion or evidence of cancer on cytology")
- null#null ("Other")