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 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="CancerTestAdditionalAskAtOrderQuestions"/>
<meta>
<profile
value="https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"/>
</meta>
<language value="en"/>
<text>
<status value="extensions"/>
<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.**
**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.</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>
<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>
<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>
<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
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.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_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>
<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
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.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_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>
<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
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.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_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>
<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
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.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_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
[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.</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>
<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>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm">
<valueCoding>
<system value="http://hl7.org/fhir/version-algorithm"/>
<code value="semver"/>
</valueCoding>
</extension>
<url
value="https://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions"/>
<version value="2.2.0"/>
<title value="Cancer Test Additional Ask At Order Entry Questions"/>
<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>