NHS North West Genomics
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Questionnaire: CYP2C19 Mavacamten (R454) Ask At Order Entry Questions

Official URL: https://fhir.nwgenomics.nhs.uk/Questionnaire/CYP2C19MavacamtenAskAtOrderEntry Version: 2.2.0
Unknown as of 2026-09-20 Computable Name:

For analysis purposes only - not an active or planned project.

Ask At Order Entry Questions for the R454 Mavacamten CYP2C19 Test Request Form (DOC6602), used alongside the common core order form - see Order Entry Questions. This is one of the leanest of the paper forms - the test itself (R454) is fixed by the choice of form, and there is no specimen-specific content beyond the common core's own Specimen group. Like several of the newer DOC-numbered forms, it captures Gender Identity separately from Biological Sex - see Genomic Test Order - Common Fields We May Have Missed for why that item is proposed as a common-core addition rather than repeated per Ask At Order Entry Questionnaire.

This Questionnaire is compared against Genomic Test Order - see NW GLH Paper Test Request Forms - but does not yet declare derivedFrom/extends it: unlike the Ask At Order Entry Questionnaires that originated from an existing digital order-entry screen (see Order Entry Questions), this one hasn't yet been processed into the specific electronic Ask At Order Entry shape that relationship implies for use in an actual order. It structures the R454 Mavacamten CYP2C19 Test Request Form (DOC6602) - see NW Genomics paper test request forms for how this compares to the other paper forms.

Source form: CYP2C19 R454 Mavacamten Test Request Form, DOC6602 (PDF)

Summary

Item Paper Form Field FHIR
Surname/Forename Free text Patient.name
D.O.B. Free text Patient.birthDate
NHS No/Hospital Number Free text Patient.identifier:nhsNumber / Patient.identifier:MedicalRecordNumber
NHS/Private Tick box not yet mapped
Patient's Address/Postcode Free text Patient.address
Biological Sex/Gender Identity Free text Patient.gender / not yet mapped
Ethnicity Coded Patient.extension:ethnicCategory
Referring Clinician/Healthcare Professional (Consultant/GP, Hospital/Surgery, Department, Contact E-mail, Requested by/Cc. Report to) Free text PractitionerRole
R454 testing required Single tick box ServiceRequest.code

This is the leanest of the ten paper forms - the test itself (R454) is fixed by the choice of form, and beyond a Gender Identity field and an NHS/Private tick box (see Genomic Test Order - Common Fields We May Have Missed) its Patient and Referring Clinician/Healthcare Professional content maps cleanly onto the common core's own Patient and Healthcare Professional groups. No Order Placer Number, Account Number/Hospital Spell Identifier, Specimen-specific field beyond the common core's own Specimen group, or clinician professional identifier (GMC/GMP) field is present on the paper form.

Profile: Questionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. **For analysis purposes only - not an active or planned project.** **Ask At Order Entry Questions** for the **R454 Mavacamten CYP2C19 Test Request Form** (DOC6602), used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). This is one of the leanest of the paper forms - the test itself (R454) is fixed by the choice of form, and there is no specimen-specific content beyond the common core's own Specimen group. Like several of the newer DOC-numbered forms, it captures **Gender Identity** separately from Biological Sex - see [Genomic Test Order - Common Fields We May Have Missed](Questionnaire-GenomicTestOrder.html#common-fields-we-may-have-missed) for why that item is proposed as a common-core addition rather than repeated per Ask At Order Entry Questionnaire. Questionnaire https://fhir.nwgenomics.nhs.uk/Questionnaire/CYP2C19MavacamtenAskAtOrderEntry#2.2.0
... Patient Patient Details 0..1 group Definition: Patient
Value Set:
.... LN/45394-4 Surname 0..1 string Definition: Patient.name.family
Value Set:
.... LN/45392-8 Forename 0..1 string Definition: Patient.name.given
Value Set:
.... LN/21112-8 D.O.B. 0..1 date Definition: Patient.birthDate
Value Set:
.... LN/89061-6 NHS No 0..1 string Definition: Patient.identifier:nhsNumber
Value Set:
.... LN/76435-7 Hospital Number 0..1 string Definition: Patient.identifier:MedicalRecordNumber
Value Set:
.... NOS/NHSOrPrivate NHS/Private 0..1 choice Value Set:
Options: 2 options
..... NOS/NHSOrPrivate-designNote No clean FHIR field identified - this form's own distinction between an NHS-funded and privately-funded request. 0..1 display Value Set:
.... LN/56799-0 Patient's Address 0..1 string Definition: Patient.address.line
Value Set:
.... LN/46098-0 Biological Sex 0..1 choice Definition: Patient.gender
Value Set: AdministrativeGender
.... LN/45401-7 Postcode 0..1 string Definition: Patient.address.postalCode
Value Set:
.... NOS/GenderIdentity Gender Identity 0..1 string Value Set:
..... NOS/GenderIdentity-designNote No clean FHIR field identified - distinct from Biological Sex on this form's own layout, same pattern as Genomic Variant Review's own Gender Identity item. 0..1 display Value Set:
.... LN/32624-9 Ethnicity 0..1 choice Definition: Patient.extension:ethnicCategory
Value Set: Ethnicity
... HealthcareProfessional Referring Clinician/Healthcare Professional 0..1 group Definition: PractitionerRole
Value Set:
.... LN/18705-4 Consultant/GP (in full) 0..1 string Definition: PractitionerRole.practitioner.display
Value Set:
.... HL7/ORC-21 Hospital/Surgery (in full) 0..1 string Definition: PractitionerRole.organization.identifier.value
Value Set:
.... LN/18707-0 Department 0..1 choice Definition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
.... LN/89058-2 Contact E-mail 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
.... NOS/RequestedByCcReportTo Requested by/Cc. Report to 0..1 string Value Set:
..... NOS/RequestedByCcReportTo-designNote Same genuinely-additional-person gap identified on Genomic Variant Review and the GMS WGS national forms' own Main Contact group - see Genomic Test Order - Common Fields We May Have Missed (Copy Report To). 0..1 display Value Set:
... AskAtOrderEntry Ask At Order Entry Questions 0..1 group Value Set:
.... NOS/R454TestingRequired R454 Mavacamten CYP2C19 testing required 1..1 boolean Definition: ServiceRequest.code
Value Set:
..... NOS/R454TestingRequired-designNote The paper form has a single tick-box rather than a choice of test codes - R454.1 is implied by using this form at all. 0..1 display Value Set:

doco Documentation for this format

Options Sets

Answer options for NOS/NHSOrPrivate

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#NHSPatient
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#PrivatePatient

Profile: Questionnaire

Patient Details

  • linkId: Patient
  • Definition:: Patient
  • Answers:

Surname

Forename

D.O.B.

NHS No

Hospital Number

NHS/Private

No clean FHIR field identified - this form's own distinction between an NHS-funded and privately-funded request.

  • linkId: NOS/NHSOrPrivate-designNote
  • Answers:

Patient's Address

Biological Sex

Postcode

Gender Identity

  • linkId: NOS/GenderIdentity
  • Answers:

No clean FHIR field identified - distinct from Biological Sex on this form's own layout, same pattern as Genomic Variant Review's own Gender Identity item.

  • linkId: NOS/GenderIdentity-designNote
  • Answers:

Ethnicity

Referring Clinician/Healthcare Professional

Consultant/GP (in full)

Hospital/Surgery (in full)

Department

Contact E-mail

Requested by/Cc. Report to

  • linkId: NOS/RequestedByCcReportTo
  • Answers:

Same genuinely-additional-person gap identified on Genomic Variant Review and the GMS WGS national forms' own Main Contact group - see Genomic Test Order - Common Fields We May Have Missed (Copy Report To).

  • linkId: NOS/RequestedByCcReportTo-designNote
  • Answers:

Ask At Order Entry Questions

  • linkId: AskAtOrderEntry
  • Answers:

R454 Mavacamten CYP2C19 testing required*

The paper form has a single tick-box rather than a choice of test codes - R454.1 is implied by using this form at all.

  • linkId: NOS/R454TestingRequired-designNote
  • Answers:

Profile: Questionnaire

LinkIDDescription & Constraintsdoco
.. Patient Definition: Patient
Value Set:
... LN/45394-4 Definition: Patient.name.family
Value Set:
... LN/45392-8 Definition: Patient.name.given
Value Set:
... LN/21112-8 Definition: Patient.birthDate
Value Set:
... LN/89061-6 Definition: Patient.identifier:nhsNumber
Value Set:
... LN/76435-7 Definition: Patient.identifier:MedicalRecordNumber
Value Set:
... NOS/NHSOrPrivate Value Set:
Options: 2 options
.... NOS/NHSOrPrivate-designNote Value Set:
... LN/56799-0 Definition: Patient.address.line
Value Set:
... LN/46098-0 Definition: Patient.gender
Value Set: AdministrativeGender
... LN/45401-7 Definition: Patient.address.postalCode
Value Set:
... NOS/GenderIdentity Value Set:
.... NOS/GenderIdentity-designNote Value Set:
... LN/32624-9 Definition: Patient.extension:ethnicCategory
Value Set: Ethnicity
.. HealthcareProfessional Definition: PractitionerRole
Value Set:
... LN/18705-4 Definition: PractitionerRole.practitioner.display
Value Set:
... HL7/ORC-21 Definition: PractitionerRole.organization.identifier.value
Value Set:
... LN/18707-0 Definition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
... LN/89058-2 Definition: PractitionerRole.telecom.value
Value Set:
... NOS/RequestedByCcReportTo Value Set:
.... NOS/RequestedByCcReportTo-designNote Value Set:
.. AskAtOrderEntry Value Set:
... NOS/R454TestingRequired Definition: ServiceRequest.code
Value Set:
.... NOS/R454TestingRequired-designNote Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.