<derivedFrom value="https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder"> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType"> <valueCoding> <system value="http://hl7.org/fhir/questionnaire-derivationType"/> <code value="extends"/> </valueCoding> </extension> </derivedFrom> <status value="draft"/> <date value="2026-09-20T05:53:36+00:00"/> <publisher value="NHS North West Genomics"/> <contact> <telecom> <system value="url"/> <value value="https://www.nwgenomics.nhs.uk/contact-us"/> </telecom> </contact> <description value="**This Questionnaire is a proposal, not an active or planned project.** **Test Specific Additional Ask At Order Entry Questions** for Cancer orders - used *alongside* the [common core order form](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry Questions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the same "Test Specific" tier pattern [WGS Test Additional Ask At Order Entry Questions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already follows for WGS orders - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). Its content is **inferred**, not yet confirmed against a live order-entry screen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below is a concept that recurs independently across the two Cancer-category NW GLH paper forms - [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national form) - see [NW GLH Paper Test Request Forms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms). Neither of those two Questionnaires has been changed to actually use this one yet - both remain independent, standalone Questionnaires, each already carrying its own copy of the fields proposed here."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="GB"/> <display value="United Kingdom of Great Britain and Northern Ireland"/> </coding> </jurisdiction> <item> <linkId value="AskAtOrderEntry"/> <text value="Ask At Order Entry Questions"/> <type value="group"/> <item> <linkId value="NOS/PresentationStatus"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept"/> <text value="Presentation status"/> <type value="choice"/> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="PresentationFirstDiagnosis"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="PresentationRecurrenceRelapse"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://loinc.org"/> <code value="LA4489-6"/> <display value="Unknown"/> </valueCoding> </answerOption> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="NOS/PresentationStatus-designNote"/> <text value="Inferred from [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own `NOS/PresentationStatus` item. Generalises the same distinction [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) makes via its own `Pathway` choice (HRD test = newly diagnosed, Tumour BRCA-only = relapsed) plus separate `NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation` booleans - that form conflates presentation status with test selection itself, since the pathway and the presentation are the same choice on that specific form; here they are kept separate, as GMS WGS Cancer already does."/> <type value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-unit"> <valueCoding> <system value="http://unitsofmeasure.org"/> <code value="%"/> <display value="%"/> </valueCoding> </extension> <linkId value="NOS/NeoplasticCellContent"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity"/> <code> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="NeoplasticCellContent"/> </code> <text value="Neoplastic/malignant cell content (%)"/> <type value="quantity"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="NOS/NeoplasticCellContent-designNote"/> <text value="The same underlying concept is independently modelled three times today, each under its own linkId despite sharing this same `NWGMSA` code: [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s `NOS/NeoplasticCellContent` ("Approximate % neoplastic nuclei in tumour area highlighted"), [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s `NOS/NeoplasticCellContent-gms` ("% Malignant nuclei / blasts (or equivalent)"), and [WGS Local Test Order](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own `NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared field this tier is for, rather than each Cancer-adjacent form continuing to reinvent its own suffixed linkId for the same value."/> <type value="display"/> </item> </item> <item> <linkId value="NOS/PathologistName"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString"/> <code> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="PathologistName"/> </code> <text value="Pathologist"/> <type value="string"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="NOS/PathologistName-designNote"/> <text value="Present as its own named field on [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask for the pathologist by name, only a Histopathology Lab ID (see `Pathology hospital / laboratory` below) - proposed here as a genuinely Cancer-wide concept even though only one of the two source forms currently asks for it."/> <type value="display"/> </item> </item> <item> <linkId value="NOS/PathologyHospital"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString"/> <code> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="PathologyHospital"/> </code> <text value="Pathology hospital / laboratory"/> <type value="string"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="NOS/PathologyHospital-designNote"/> <text value="Generalises [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own `NOS/PathologyHospital` and [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s `NOS/HistopathologyLabID` ("Histopathology Lab ID", under that form's own Solid tumour sub-group) - both identify where the pathology specimen/report the order relies on came from, just at different granularity (a named hospital vs. a lab identifier). Kept as free text pending a decision on whether an [Organisation Code](StructureDefinition-OrganisationCode.html) reference would be more appropriate."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="NOS/PathologyHospital-futureQueryAccess"/> <text value="This item, and Pathologist above, most directly relate to the [Cheshire and Merseyside Pathology](CheshireAndMerseysidePathology.html) reflex use case, where a genomic order follows on from a prior pathology order/report (`LAB-1`/`LAB-3`) rather than starting the clinical episode itself. That page's own [Current Process](CheshireAndMerseysidePathology.html#current-process) still models the pathology-to-genomics handoff entirely as HL7 v2/FHIR messaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's answer is free text naming the pathologist/hospital rather than a machine-resolvable reference. A query-based alternative may remove the need to duplicate pathology content into the genomic order/message at all: some NW pathology LIMS deployments (e.g. Medicus) already support the Australian [AU eReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand query access to pathology orders (and potentially reports), and MFT separately exposes pathology data through Epic's own [FHIR Query API](https://fhir.epic.com/). If a genomics laboratory can query pathology directly, these two free-text fields could be replaced by a **reference** instead - the Pathology Order Filler Number, Pathology Patient Identifier and/or Pathology Specimen Identifier - letting the genomic order carry a pointer for on-demand lookup rather than the pathology detail itself."/> <type value="display"/> </item> </item> </item> </Questionnaire>

Generated Narrative: Questionnaire CancerTestAdditionalAskAtOrderQuestions

Structure

Options Sets

Answer options for NOS/PresentationStatus