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

## : Private Colposcopy Referral Summary Questionnaire - XML Representation

Draft as of 2025-12-11

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    <Questionnaire xmlns="http://hl7.org/fhir">
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire PrivateColposcopyReferralQuestionnaire</b></p><a name="PrivateColposcopyReferralQuestionnaire"> </a><a name="hcPrivateColposcopyReferralQuestionnaire"> </a><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> PrivateColposcopyReferralQuestionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PrivateColposcopyReferralQuestionnaire#0.1.1</td></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p01-ClinicInformation" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> p01-ClinicInformation</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 01. Clinic Information</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p01-q01-FacilityID" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-reference.png" alt="." style="background-color: white; background-color: inherit" title="reference" class="hierarchy"/> p01-q01-FacilityID</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 01 question 1. Colposcopy HPI facility ID</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-reference">reference</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p02-ReferralInformation" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> p02-ReferralInformation</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02. Referral Information</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)" id="item.p02-q01-SelfReferral" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="boolean" class="hierarchy"/> p02-q01-SelfReferral</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 1. Self Referral?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)" id="item.p02-q02.1-SelfReferral" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> p02-q02.1-SelfReferral</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 2.1. If your patient has self-referred enter in their GP’s HPI-CPN and HPI Health Facility ID</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q02-ReferredByName" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-reference.png" alt="." style="background-color: white; background-color: inherit" title="reference" class="hierarchy"/> p02-q02-ReferredByName</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 2. Referred by health worker name</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-reference">reference</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q03-ReferredByFacilityID" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-reference.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="reference" class="hierarchy"/> p02-q03-ReferredByFacilityID</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 3. Referred by health facility ID</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-reference">reference</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q04-ReferralDateReceived" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> p02-q04-ReferralDateReceived</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 5. Referral received date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q05-ReferralDateAccepted" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="date" class="hierarchy"/> p02-q05-ReferralDateAccepted</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 6. Referral accepted date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q06-AppointmentDate" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> p02-q06-AppointmentDate</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 7. Appointment date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q07-FirstVisit" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> p02-q07-FirstVisit</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 8. First colposcopy visit?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q8-FollowUpType" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> p02-q8-FollowUpType</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 9. Follow-up Colposcopy Visit</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p02-q07-FirstVisit">p02-q07-FirstVisit</a> = </span><br/>Options: <a href="#opt-item.p02-q8-FollowUpType">4 options</a></td></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p02-q9-FollowUpTimeFrame" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p02-q9-FollowUpTimeFrame</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 9. Follow-up timeframe</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p02-q07-FirstVisit">p02-q07-FirstVisit</a> = </span><br/>Options: <a href="#opt-item.p02-q9-FollowUpTimeFrame">15 options</a></td></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item.p03-RefferalReason" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> p03-RefferalReason</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03. Reason for Referral</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p03-q01-AssessmentReason" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p03-q01-AssessmentReason</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03 question 1. Assessment for the reason for referral</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.p03-q01-AssessmentReason">12 options</a></td></tr>
    <tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)" id="item.p03-q02-OtherReason" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> p03-q02-OtherReason</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03 question 2. Other Reason (if Any)</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p03-q01-AssessmentReason">p03-q01-AssessmentReason</a> = </span></td></tr>
    <tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.p02-q8-FollowUpType"> </a><p><b>Answer options for p02-q8-FollowUpType </b></p><ul><li style="font-size: 11px">null#null (&quot;1st Follow Up Visit&quot;)</li><li style="font-size: 11px">null#null (&quot;2nd Follow Up Visit&quot;)</li><li style="font-size: 11px">null#null (&quot;3rd Follow Up Visit&quot;)</li><li style="font-size: 11px">null#null (&quot;4th or more Follow up Visit&quot;)</li></ul><a name="opt-item.p02-q9-FollowUpTimeFrame"> </a><p><b>Answer options for p02-q9-FollowUpTimeFrame </b></p><ul><li style="font-size: 11px">null#7D (&quot;7 Days&quot;)</li><li style="font-size: 11px">null#2W (&quot;2 Weeks&quot;)</li><li style="font-size: 11px">null#6W (&quot;6 Weeks&quot;)</li><li style="font-size: 11px">null#1M (&quot;1 Month&quot;)</li><li style="font-size: 11px">null#2M (&quot;2 Months&quot;)</li><li style="font-size: 11px">null#3M (&quot;3 Months&quot;)</li><li style="font-size: 11px">null#4M (&quot;4 Months&quot;)</li><li style="font-size: 11px">null#5M (&quot;5 Months&quot;)</li><li style="font-size: 11px">null#6M (&quot;6 Months&quot;)</li><li style="font-size: 11px">null#7M (&quot;7 Months&quot;)</li><li style="font-size: 11px">null#9M (&quot;9 Months&quot;)</li><li style="font-size: 11px">null#12M (&quot;12 Months&quot;)</li><li style="font-size: 11px">null#18M (&quot;18 Months&quot;)</li><li style="font-size: 11px">null#36M (&quot;36 Months&quot;)</li><li style="font-size: 11px">null#60M (&quot;60 Months&quot;)</li></ul><a name="opt-item.p03-q01-AssessmentReason"> </a><p><b>Answer options for p03-q01-AssessmentReason </b></p><ul><li style="font-size: 11px">null#null (&quot;Any cytological evidence or suspicion of invasion&quot;)</li><li style="font-size: 11px">null#null (&quot;Any cytological glandular abnormality&quot;)</li><li style="font-size: 11px">null#null (&quot;HPV 16/18 with or without cytology&quot;)</li><li style="font-size: 11px">null#null (&quot;HPV other where the participant is immune compromised&quot;)</li><li style="font-size: 11px">null#null (&quot;HPV other with LSIL on two occasions if over 50 and 3 occasions if under 50&quot;)</li><li style="font-size: 11px">null#null (&quot;Positive test of cure&quot;)</li><li style="font-size: 11px">null#null (&quot;Low-grade clinical assessment&quot;)</li><li style="font-size: 11px">null#null (&quot;High-grade clinical assessment&quot;)</li><li style="font-size: 11px">null#null (&quot;Suspicion of an invasive cancer clinical assessment&quot;)</li><li style="font-size: 11px">null#null (&quot;HPV not detected with high-grade cytology&quot;)</li><li style="font-size: 11px">null#null (&quot;HPV not detected with suspicion or evidence of cancer on cytology&quot;)</li><li style="font-size: 11px">null#null (&quot;Other&quot;)</li></ul></div>
      </text>
      <url
           value="https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PrivateColposcopyReferralQuestionnaire"/>
      <identifier>
        <use value="official"/>
        <value value="PrivateColposcopyReferralQuestionnaire"/>
      </identifier>
      <version value="0.1.1"/>
      <name value="PrivateColposcopyReferralQuestionnaire"/>
      <title value="Private Colposcopy Referral Summary Questionnaire"/>
      <status value="draft"/>
      <experimental value="false"/>
      <subjectType value="Patient"/>
      <date value="2025-12-11T23:52:07+00:00"/>
      <publisher value="Te Whatu Ora"/>
      <contact>
        <name value="Te Whatu Ora"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.tewhatuora.govt.nz/"/>
        </telecom>
      </contact>
      <contact>
        <name value="Te Whatu Ora Integration Team"/>
        <telecom>
          <system value="email"/>
          <value value="integration@tewhatuora.govt.nz"/>
          <use value="work"/>
        </telecom>
      </contact>
      <useContext>
        <code>
          <system
                  value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
          <code value="workflow"/>
          <display value="Workflow Setting"/>
        </code>
        <valueCodeableConcept>
          <text value="Private Colposcopy Visit Summary"/>
        </valueCodeableConcept>
      </useContext>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="NZ"/>
          <display value="New Zealand"/>
        </coding>
      </jurisdiction>
      <purpose
               value="To gather the referral details of Private colposcopy procedure."/>
      <item>
        <linkId value="p01-ClinicInformation"/>
        <prefix value="page 01"/>
        <text value="Clinic Information"/>
        <type value="group"/>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource">
            <valueCode value="Location"/>
          </extension>
          <linkId value="p01-q01-FacilityID"/>
          <prefix value="page 01 question 1"/>
          <text value="Colposcopy HPI facility ID"/>
          <type value="reference"/>
          <required value="true"/>
        </item>
      </item>
      <item>
        <linkId value="p02-ReferralInformation"/>
        <prefix value="page 02"/>
        <text value="Referral Information"/>
        <type value="group"/>
        <item>
          <linkId value="p02-q01-SelfReferral"/>
          <prefix value="page 02 question 1"/>
          <text value="Self Referral?"/>
          <type value="boolean"/>
          <required value="true"/>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="help"/>
                  <display value="Help-Button"/>
                </coding>
                <text value="Help-Button"/>
              </valueCodeableConcept>
            </extension>
            <linkId value="p02-q02.1-SelfReferral"/>
            <prefix value="page 02 question 2.1"/>
            <text
                  value="If your patient has self-referred enter in their GP’s HPI-CPN and HPI Health Facility ID"/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource">
            <valueCode value="Practitioner"/>
          </extension>
          <linkId value="p02-q02-ReferredByName"/>
          <prefix value="page 02 question 2"/>
          <text value="Referred by health worker name"/>
          <type value="reference"/>
          <required value="true"/>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource">
            <valueCode value="Location"/>
          </extension>
          <linkId value="p02-q03-ReferredByFacilityID"/>
          <prefix value="page 02 question 3"/>
          <text value="Referred by health facility ID"/>
          <type value="reference"/>
          <required value="true"/>
        </item>
        <item>
          <linkId value="p02-q04-ReferralDateReceived"/>
          <prefix value="page 02 question 5"/>
          <text value="Referral received date"/>
          <type value="date"/>
          <required value="false"/>
        </item>
        <item>
          <linkId value="p02-q05-ReferralDateAccepted"/>
          <prefix value="page 02 question 6"/>
          <text value="Referral accepted date"/>
          <type value="date"/>
          <required value="true"/>
        </item>
        <item>
          <linkId value="p02-q06-AppointmentDate"/>
          <prefix value="page 02 question 7"/>
          <text value="Appointment date"/>
          <type value="date"/>
          <required value="false"/>
        </item>
        <item>
          <linkId value="p02-q07-FirstVisit"/>
          <prefix value="page 02 question 8"/>
          <text value="First colposcopy visit?"/>
          <type value="boolean"/>
          <required value="true"/>
          <repeats value="false"/>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="drop-down"/>
                <display value="Drop down"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="p02-q8-FollowUpType"/>
          <prefix value="page 02 question 9"/>
          <text value="Follow-up Colposcopy Visit"/>
          <type value="choice"/>
          <enableWhen>
            <question value="p02-q07-FirstVisit"/>
            <operator value="="/>
            <answerBoolean value="false"/>
          </enableWhen>
          <enableBehavior value="all"/>
          <required value="true"/>
          <repeats value="false"/>
          <answerOption>
            <valueCoding>
              <display value="1st Follow Up Visit"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="2nd Follow Up Visit"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="3rd Follow Up Visit"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="4th or more Follow up Visit"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="drop-down"/>
                <display value="Drop down"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="p02-q9-FollowUpTimeFrame"/>
          <prefix value="page 02 question 9"/>
          <text value="Follow-up timeframe"/>
          <type value="choice"/>
          <enableWhen>
            <question value="p02-q07-FirstVisit"/>
            <operator value="="/>
            <answerBoolean value="false"/>
          </enableWhen>
          <enableBehavior value="all"/>
          <required value="true"/>
          <repeats value="false"/>
          <answerOption>
            <valueCoding>
              <code value="7D"/>
              <display value="7 Days"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="2W"/>
              <display value="2 Weeks"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="6W"/>
              <display value="6 Weeks"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="1M"/>
              <display value="1 Month"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="2M"/>
              <display value="2 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="3M"/>
              <display value="3 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="4M"/>
              <display value="4 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="5M"/>
              <display value="5 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="6M"/>
              <display value="6 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="7M"/>
              <display value="7 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="9M"/>
              <display value="9 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="12M"/>
              <display value="12 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="18M"/>
              <display value="18 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="36M"/>
              <display value="36 Months"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <code value="60M"/>
              <display value="60 Months"/>
            </valueCoding>
          </answerOption>
        </item>
      </item>
      <item>
        <linkId value="p03-RefferalReason"/>
        <prefix value="page 03"/>
        <text value="Reason for Referral"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="false"/>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="drop-down"/>
                <display value="Drop down"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="p03-q01-AssessmentReason"/>
          <prefix value="page 03 question 1"/>
          <text value="Assessment for the reason for referral"/>
          <type value="choice"/>
          <required value="true"/>
          <repeats value="false"/>
          <answerOption>
            <valueCoding>
              <display value="Any cytological evidence or suspicion of invasion"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="Any cytological glandular abnormality"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="HPV 16/18 with or without cytology"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display
                       value="HPV other where the participant is immune compromised"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display
                       value="HPV other with LSIL on two occasions if over 50 and 3 occasions if under 50"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="Positive test of cure"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="Low-grade clinical assessment"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="High-grade clinical assessment"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display
                       value="Suspicion of an invasive cancer clinical assessment"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="HPV not detected with high-grade cytology"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display
                       value="HPV not detected with suspicion or evidence of cancer on cytology"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <display value="Other"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <linkId value="p03-q02-OtherReason"/>
          <prefix value="page 03 question 2"/>
          <text value="Other Reason (if Any)"/>
          <type value="string"/>
          <enableWhen>
            <question value="p03-q01-AssessmentReason"/>
            <operator value="="/>
            <answerCoding>
              <display value="Other"/>
            </answerCoding>
          </enableWhen>
          <enableBehavior value="all"/>
        </item>
      </item>
    </Questionnaire>