NHS North West Genomics
2.2.0 - ci-build
NHS North West Genomics
2.2.0 - ci-build
NHS North West Genomics - Local Development build (v2.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2026-09-20 |
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🔗 "https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire CancerTestAdditionalAskAtOrderQuestions</b></p><a name=\"CancerTestAdditionalAskAtOrderQuestions\"> </a><a name=\"hcCancerTestAdditionalAskAtOrderQuestions\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-NWQuestionnaire.html\">Questionnaire</a></p></div><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 & 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\"/> </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\">**This Questionnaire is a proposal, not an active or planned project.**\n\n**Test Specific Additional Ask At Order Entry Questions** for Cancer\norders - used *alongside* the [common core order\nform](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry\nQuestions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the\nsame "Test Specific" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already\nfollows for WGS orders - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions).\n\nIts content is **inferred**, not yet confirmed against a live order-entry\nscreen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below\nis a concept that recurs independently across the two Cancer-category NW\nGLH paper forms - [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS\nWGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national\nform) - see [NW GLH Paper Test Request\nForms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms).\nNeither of those two Questionnaires has been changed to actually use this\none yet - both remain independent, standalone Questionnaires, each already\ncarrying its own copy of the fields proposed here.</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\">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://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions#2.2.0</td></tr>\r\n<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_bck01.png)\" id=\"item.AskAtOrderEntry\" 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: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> AskAtOrderEntry</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\">Ask At Order Entry Questions</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>\r\n<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_bck011.png)\" id=\"item.NOS/PresentationStatus\" 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: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> NOS/PresentationStatus</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\">Presentation status</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-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\">Definition: <a href=\"http://hl7.org/fhir/R4/observation.html#Observation.valueCodeableConcept\">Observation.valueCodeableConcept</a><br/>Options: <a href=\"#opt-item.NOS/PresentationStatus\">3 options</a></td></tr>\r\n<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_bck0100.png)\" id=\"item.NOS/PresentationStatus-designNote\" 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_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\"/> NOS/PresentationStatus-designNote</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\">Inferred from [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own\n`NOS/PresentationStatus` item. Generalises the same distinction [HRD\nand Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)\nmakes via its own `Pathway` choice (HRD test = newly diagnosed,\nTumour BRCA-only = relapsed) plus separate\n`NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation`\nbooleans - that form conflates presentation status with test\nselection itself, since the pathway and the presentation are the same\nchoice on that specific form; here they are kept separate, as GMS WGS\nCancer already does.</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>\r\n<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_bck011.png)\" id=\"item.NOS/NeoplasticCellContent\" 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-quantity.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"quantity\" class=\"hierarchy\"/> NOS/NeoplasticCellContent</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\">Neoplastic/malignant cell content (%)</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-quantity\">quantity</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\">Definition: <a href=\"http://hl7.org/fhir/R4/observation.html#Observation.valueQuantity\">Observation.valueQuantity</a></td></tr>\r\n<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_bck0100.png)\" id=\"item.NOS/NeoplasticCellContent-designNote\" 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_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\"/> NOS/NeoplasticCellContent-designNote</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\">The same underlying concept is independently modelled three times\ntoday, each under its own linkId despite sharing this same\n`NWGMSA` code: [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent` ("Approximate % neoplastic nuclei in\ntumour area highlighted"), [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent-gms` ("% Malignant nuclei / blasts (or\nequivalent)"), and [WGS Local Test\nOrder](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own\n`NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared\nfield this tier is for, rather than each Cancer-adjacent form\ncontinuing to reinvent its own suffixed linkId for the same value.</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>\r\n<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_bck011.png)\" id=\"item.NOS/PathologistName\" 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-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> NOS/PathologistName</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\">Pathologist</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\">Definition: <a href=\"http://hl7.org/fhir/R4/observation.html#Observation.valueString\">Observation.valueString</a></td></tr>\r\n<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_bck0100.png)\" id=\"item.NOS/PathologistName-designNote\" 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_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\"/> NOS/PathologistName-designNote</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\">Present as its own named field on [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask\nfor the pathologist by name, only a Histopathology Lab ID (see\n`Pathology hospital / laboratory` below) - proposed here as a\ngenuinely Cancer-wide concept even though only one of the two source\nforms currently asks for it.</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>\r\n<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_bck001.png)\" id=\"item.NOS/PathologyHospital\" 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\"/> NOS/PathologyHospital</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\">Pathology hospital / laboratory</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\">Definition: <a href=\"http://hl7.org/fhir/R4/observation.html#Observation.valueString\">Observation.valueString</a></td></tr>\r\n<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_bck0010.png)\" id=\"item.NOS/PathologyHospital-designNote\" 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_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-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> NOS/PathologyHospital-designNote</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\">Generalises [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own\n`NOS/PathologyHospital` and [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/HistopathologyLabID` ("Histopathology Lab ID", under that form's\nown Solid tumour sub-group) - both identify where the pathology\nspecimen/report the order relies on came from, just at different\ngranularity (a named hospital vs. a lab identifier). Kept as free\ntext pending a decision on whether an\n[Organisation Code](StructureDefinition-OrganisationCode.html)\nreference would be more appropriate.</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>\r\n<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_bck0000.png)\" id=\"item.NOS/PathologyHospital-futureQueryAccess\" 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_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-display.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> NOS/PathologyHospital-futureQueryAccess</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\">This item, and Pathologist above, most directly relate to the\n[Cheshire and Merseyside\nPathology](CheshireAndMerseysidePathology.html) reflex use case, where\na genomic order follows on from a prior pathology order/report\n(`LAB-1`/`LAB-3`) rather than starting the clinical episode itself.\nThat page's own [Current\nProcess](CheshireAndMerseysidePathology.html#current-process) still\nmodels the pathology-to-genomics handoff entirely as HL7 v2/FHIR\nmessaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's\nanswer is free text naming the pathologist/hospital rather than a\nmachine-resolvable reference.\n\nA query-based alternative may remove the need to duplicate pathology\ncontent into the genomic order/message at all: some NW pathology LIMS\ndeployments (e.g. Medicus) already support the Australian [AU\neReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand\nquery access to pathology orders (and potentially reports), and MFT\nseparately exposes pathology data through Epic's own [FHIR Query\nAPI](https://fhir.epic.com/). If a genomics laboratory can query\npathology directly, these two free-text fields could be replaced by a\n**reference** instead - the Pathology Order Filler Number, Pathology\nPatient Identifier and/or Pathology Specimen Identifier - letting the\ngenomic order carry a pointer for on-demand lookup rather than the\npathology detail itself.</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-display\">display</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>\r\n<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.NOS/PresentationStatus\"> </a><p><b>Answer options for NOS/PresentationStatus </b></p><ul><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#PresentationFirstDiagnosis</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#PresentationRecurrenceRelapse</li><li style=\"font-size: 11px\">http://loinc.org#LA4489-6 ("Unknown")</li></ul></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
"valueCoding" : {
"system" : "http://hl7.org/fhir/version-algorithm",
"code" : "semver"
}
}
],
"url" : "https://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions",
"version" : "2.2.0",
"title" : "Cancer Test Additional Ask At Order Entry Questions",
"derivedFrom" : [
🔗 "https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder"
],
"_derivedFrom" : [
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType",
"valueCoding" : {
"system" : "http://hl7.org/fhir/questionnaire-derivationType",
"code" : "extends"
}
}
]
}
],
"status" : "draft",
"date" : "2026-09-20T05:53:36+00:00",
"publisher" : "NHS North West Genomics",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.nwgenomics.nhs.uk/contact-us"
}
]
}
],
"description" : "**This Questionnaire is a proposal, not an active or planned project.**\n\n**Test Specific Additional Ask At Order Entry Questions** for Cancer\norders - used *alongside* the [common core order\nform](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry\nQuestions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the\nsame \"Test Specific\" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already\nfollows for WGS orders - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions).\n\nIts content is **inferred**, not yet confirmed against a live order-entry\nscreen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below\nis a concept that recurs independently across the two Cancer-category NW\nGLH paper forms - [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS\nWGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national\nform) - see [NW GLH Paper Test Request\nForms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms).\nNeither of those two Questionnaires has been changed to actually use this\none yet - both remain independent, standalone Questionnaires, each already\ncarrying its own copy of the fields proposed here.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "GB",
"display" : "United Kingdom of Great Britain and Northern Ireland"
}
]
}
],
"item" : [
{
"linkId" : "AskAtOrderEntry",
"text" : "Ask At Order Entry Questions",
"type" : "group",
"item" : [
{
"linkId" : "NOS/PresentationStatus",
"definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept",
"text" : "Presentation status",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "PresentationFirstDiagnosis"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "PresentationRecurrenceRelapse"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA4489-6",
"display" : "Unknown"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "NOS/PresentationStatus-designNote",
"text" : "Inferred from [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own\n`NOS/PresentationStatus` item. Generalises the same distinction [HRD\nand Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)\nmakes via its own `Pathway` choice (HRD test = newly diagnosed,\nTumour BRCA-only = relapsed) plus separate\n`NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation`\nbooleans - that form conflates presentation status with test\nselection itself, since the pathway and the presentation are the same\nchoice on that specific form; here they are kept separate, as GMS WGS\nCancer already does.",
"type" : "display"
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding" : {
"system" : "http://unitsofmeasure.org",
"code" : "%",
"display" : "%"
}
}
],
"linkId" : "NOS/NeoplasticCellContent",
"definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity",
"code" : [
{
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "NeoplasticCellContent"
}
],
"text" : "Neoplastic/malignant cell content (%)",
"type" : "quantity",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "NOS/NeoplasticCellContent-designNote",
"text" : "The same underlying concept is independently modelled three times\ntoday, each under its own linkId despite sharing this same\n`NWGMSA` code: [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent` (\"Approximate % neoplastic nuclei in\ntumour area highlighted\"), [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent-gms` (\"% Malignant nuclei / blasts (or\nequivalent)\"), and [WGS Local Test\nOrder](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own\n`NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared\nfield this tier is for, rather than each Cancer-adjacent form\ncontinuing to reinvent its own suffixed linkId for the same value.",
"type" : "display"
}
]
},
{
"linkId" : "NOS/PathologistName",
"definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"code" : [
{
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "PathologistName"
}
],
"text" : "Pathologist",
"type" : "string",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "NOS/PathologistName-designNote",
"text" : "Present as its own named field on [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask\nfor the pathologist by name, only a Histopathology Lab ID (see\n`Pathology hospital / laboratory` below) - proposed here as a\ngenuinely Cancer-wide concept even though only one of the two source\nforms currently asks for it.",
"type" : "display"
}
]
},
{
"linkId" : "NOS/PathologyHospital",
"definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"code" : [
{
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "PathologyHospital"
}
],
"text" : "Pathology hospital / laboratory",
"type" : "string",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "NOS/PathologyHospital-designNote",
"text" : "Generalises [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own\n`NOS/PathologyHospital` and [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/HistopathologyLabID` (\"Histopathology Lab ID\", under that form's\nown Solid tumour sub-group) - both identify where the pathology\nspecimen/report the order relies on came from, just at different\ngranularity (a named hospital vs. a lab identifier). Kept as free\ntext pending a decision on whether an\n[Organisation Code](StructureDefinition-OrganisationCode.html)\nreference would be more appropriate.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "NOS/PathologyHospital-futureQueryAccess",
"text" : "This item, and Pathologist above, most directly relate to the\n[Cheshire and Merseyside\nPathology](CheshireAndMerseysidePathology.html) reflex use case, where\na genomic order follows on from a prior pathology order/report\n(`LAB-1`/`LAB-3`) rather than starting the clinical episode itself.\nThat page's own [Current\nProcess](CheshireAndMerseysidePathology.html#current-process) still\nmodels the pathology-to-genomics handoff entirely as HL7 v2/FHIR\nmessaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's\nanswer is free text naming the pathologist/hospital rather than a\nmachine-resolvable reference.\n\nA query-based alternative may remove the need to duplicate pathology\ncontent into the genomic order/message at all: some NW pathology LIMS\ndeployments (e.g. Medicus) already support the Australian [AU\neReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand\nquery access to pathology orders (and potentially reports), and MFT\nseparately exposes pathology data through Epic's own [FHIR Query\nAPI](https://fhir.epic.com/). If a genomics laboratory can query\npathology directly, these two free-text fields could be replaced by a\n**reference** instead - the Pathology Order Filler Number, Pathology\nPatient Identifier and/or Pathology Specimen Identifier - letting the\ngenomic order carry a pointer for on-demand lookup rather than the\npathology detail itself.",
"type" : "display"
}
]
}
]
}
]
}