<?xml version="1.0" encoding="UTF-8"?><Questionnaire xmlns="http://hl7.org/fhir"><id value="PrivateColposcopyReferralQuestionnaire"/><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><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 id="item.p01-ClinicInformation" 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)" 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 id="item.p01-q01-FacilityID" 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)" 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 id="item.p02-ReferralInformation" 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)" 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 id="item.p02-q01-SelfReferral" 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)" 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 id="item.p02-q02.1-SelfReferral" 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)" 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 id="item.p02-q02-ReferredByName" 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)" 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 id="item.p02-q03-ReferredByFacilityID" 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)" 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 id="item.p02-q04-ReferralDateReceived" 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)" 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 id="item.p02-q05-ReferralDateAccepted" 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)" 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 id="item.p02-q06-AppointmentDate" 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)" 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 id="item.p02-q07-FirstVisit" 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)" 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 id="item.p02-q8-FollowUpType" 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)" 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 id="item.p02-q9-FollowUpTimeFrame" 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)" 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 id="item.p03-RefferalReason" 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)" 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 id="item.p03-q01-AssessmentReason" 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)" 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 id="item.p03-q02-OtherReason" 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)" 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="2026-03-03T21:51:04+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>