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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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire ChimerismTestAdditionalAskAtOrderQuestions</b></p><a name=\"ChimerismTestAdditionalAskAtOrderQuestions\"> </a><a name=\"hcChimerismTestAdditionalAskAtOrderQuestions\"> </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\">**Test Specific Additional Ask At Order Entry Questions** used alongside the\n[common core order form](Questionnaire-GenomicTestOrder.html) for the\n"Chimerism Testing Blood (PB)" order screen within Histocompatibility and\nImmunogenetics orders (SNOMED CT `909871000000100`) - the same "Test\nSpecific" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) follows\nfor WGS orders - see\n[Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions) and\n[Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions).\nFor the sibling HLA testing order screen, see\n[HLA Tests - Transplant Ask At Order Entry](Questionnaire-HLATestsTransplantAskAtOrderEntry.html).\n\nExtracted from the `NTE` segments of a live Histotrac `ORM^O01` order for a Chimerism\nTesting (Performable) test - see the worked\n[example](HistocompatibilityAndImmunogenetics.html#chimerism-testing-ask-at-order-entry)\nfor the full message. Unlike HLA Tests - Transplant, this order carries only two `NTE`\nsegments, and in the reverse order (Specimen Source before Patient Test(s)). See also\n[Chimerism Testing Result Panel](Questionnaire-ChimerismResultPanel.html) for the\n(separate) structured *result* payload this order eventually produces.\n\n**Research summary**: as with [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html),\nno NHS England or NHSBT-published order-comms/interoperability standard was found\nspecifically for Chimerism testing order entry. NHSBT's INF136 "User Guide for\nHistocompatibility and Immunogenetics Diagnostics Services" defines `FRM1010` "H&I\nHaematopoietic Stem Cell Transplantation (Recipients & Donors)" as the relevant national\nrequest form for post-transplant chimerism monitoring, but does not publish a\nFHIR/LOINC/SNOMED binding for the specific test-panel or specimen-source values Hive\nuses. See each item below for candidate LOINC/SNOMED codes.</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/ChimerismTestAdditionalAskAtOrderQuestions#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.ChimIG/specimen_source\" 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\"/> ChimIG/specimen_source</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\">Specimen Source</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/specimen.html#Specimen.type.coding.code\">Specimen.type.coding.code</a><br/>Options: <a href=\"#opt-item.ChimIG/specimen_source\">2 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_bck0110.png)\" id=\"item.ChimIG/specimen_source-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.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\"/> ChimIG/specimen_source-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\">Confirmed as this 2-value list (Blood (PB), Bone Marrow (BM)) from the\nHive/Histotrac order-entry UI's Chimerism panel - a different list from the\nBlood/Buccal/Other list [HLA Tests -\nTransplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) uses for the\nsame underlying `code` (LOINC `66746-9`), since the two order screens offer\ndifferent specimen-source options in Hive. Coded locally against the\n`NWGMSA` CodeSystem rather than the EU/UK/NW-compatible\n[Specimen Type](ValueSet-specimen-type.html) value set, to match what Hive\nactually offers for this exchange. Deliberately given its own\n`ChimIG/specimen_source` linkId rather than reusing the base [Genomic Test\nOrder](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type\nitem - the IG Publisher's Questionnaire derivation validator does not support a\n`derivedFrom`/`extends` item reusing a base item's linkId while also declaring\nmore than one `answerOption`. Ordered first (before Patient Test(s)) to match\n`NTE|1` in the live Histotrac order - the reverse of HLA Tests - Transplant, where\nPatient Test(s) comes first.</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_bck0100.png)\" id=\"item.ChimIG/specimen_source-reference\" 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: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> ChimIG/specimen_source-reference</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\">Post-transplant chimerism monitoring conventionally uses peripheral blood, with\nbone marrow used for deeper/marrow-level engraftment assessment - consistent with\nthis 2-value list. If a coded alternative to the local `NWGMSA` codes is wanted,\nthe [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate\nbinding (e.g. whole blood specimen for Blood (PB); bone marrow specimen for Bone\nMarrow (BM)). No dedicated NHS-published specimen-type binding specific to H&I\nchimerism testing was found.</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 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_bck001.png)\" id=\"item.ChimIG/patient_test\" 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-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> ChimIG/patient_test</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\">Patient Test(s)</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..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Definition: <a href=\"http://hl7.org/fhir/R4/servicerequest.html#ServiceRequest.orderDetail\">ServiceRequest.orderDetail</a><br/>Options: <a href=\"#opt-item.ChimIG/patient_test\">5 options</a></td></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_bck0010.png)\" id=\"item.ChimIG/patient_test-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: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> ChimIG/patient_test-designNote</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\">Which chimerism panel/lineage is being tested - the same Ask At Order Entry\npattern as `HistoIG/patient_test` on\n[HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html)\n(`repeats = true`, since the Hive UI presents them as checkboxes - more than one\nmay be selected per order). Confirmed as this fixed 5-value checklist from the\nHive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem, as\nno NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists. Ordered second\n(after Specimen Source) to match `NTE|2` in the live Histotrac order, whose\nNTE-3 value carries a `(PB)` suffix ("Chimerism Peripheral Blood (PB)") the Hive\ncheckbox label itself doesn't show - the same OBR-4-restatement behaviour as HLA\nTests - Transplant's Patient Test(s) item. Mapped to `ServiceRequest.orderDetail`\nrather than `ServiceRequest.code` - the same reasoning as that item:\n`ServiceRequest.code` is single-cardinality and already targeted by the base\n[Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item,\nwith no `enableWhen` to say which wins, while `orderDetail` is repeating and\nintended for exactly this kind of further order qualifier.</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 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_bck0000.png)\" id=\"item.ChimIG/patient_test-reference\" 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: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> ChimIG/patient_test-reference</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\">No MFT/NHS England code set was found for these five specific test names. LOINC\nhas short tandem repeat (STR)/chimerism-adjacent panels (e.g. `48018-6` Gene\nstudied, engraftment-monitoring local codes used elsewhere in genetics\nlaboratories) but no exact match for a CD3/CD15/CD19 lineage-specific chimerism\nchecklist was confirmed - a candidate future binding if a coded alternative to\nthe local `NWGMSA` codes is wanted. See also this IG's existing\n[Chimerism](CodeSystem-Chimerism.html) CodeSystem, which covers the *result*\npayload's OBX-3 sub-identifiers (STR/IM/RANGE/CV/EXT/PURE/POST/DTP/DID) rather\nthan these order-entry test-selection values.</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><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.ChimIG/specimen_source\"> </a><p><b>Answer options for ChimIG/specimen_source </b></p><ul><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismBloodPB ("Blood (PB)")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismBoneMarrowBM ("Bone Marrow (BM)")</li></ul><a name=\"opt-item.ChimIG/patient_test\"> </a><p><b>Answer options for ChimIG/patient_test </b></p><ul><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismPeripheralBlood ("Chimerism Peripheral Blood")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismCD3 ("Chimerism CD3")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismCD15 ("Chimerism CD15")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismCD19 ("Chimerism CD19")</li><li style=\"font-size: 11px\">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismLineageOther ("Chimerism Lineage Other")</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/ChimerismTestAdditionalAskAtOrderQuestions",
"version" : "2.2.0",
"title" : "Chimerism Testing Blood (PB) Ask At Order Entry",
"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" : "**Test Specific Additional Ask At Order Entry Questions** used alongside the\n[common core order form](Questionnaire-GenomicTestOrder.html) for the\n\"Chimerism Testing Blood (PB)\" order screen within Histocompatibility and\nImmunogenetics orders (SNOMED CT `909871000000100`) - the same \"Test\nSpecific\" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) follows\nfor WGS orders - see\n[Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions) and\n[Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions).\nFor the sibling HLA testing order screen, see\n[HLA Tests - Transplant Ask At Order Entry](Questionnaire-HLATestsTransplantAskAtOrderEntry.html).\n\nExtracted from the `NTE` segments of a live Histotrac `ORM^O01` order for a Chimerism\nTesting (Performable) test - see the worked\n[example](HistocompatibilityAndImmunogenetics.html#chimerism-testing-ask-at-order-entry)\nfor the full message. Unlike HLA Tests - Transplant, this order carries only two `NTE`\nsegments, and in the reverse order (Specimen Source before Patient Test(s)). See also\n[Chimerism Testing Result Panel](Questionnaire-ChimerismResultPanel.html) for the\n(separate) structured *result* payload this order eventually produces.\n\n**Research summary**: as with [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html),\nno NHS England or NHSBT-published order-comms/interoperability standard was found\nspecifically for Chimerism testing order entry. NHSBT's INF136 \"User Guide for\nHistocompatibility and Immunogenetics Diagnostics Services\" defines `FRM1010` \"H&I\nHaematopoietic Stem Cell Transplantation (Recipients & Donors)\" as the relevant national\nrequest form for post-transplant chimerism monitoring, but does not publish a\nFHIR/LOINC/SNOMED binding for the specific test-panel or specimen-source values Hive\nuses. See each item below for candidate LOINC/SNOMED codes.",
"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" : "ChimIG/specimen_source",
"definition" : "http://hl7.org/fhir/StructureDefinition/Specimen#Specimen.type.coding.code",
"code" : [
{
"system" : "http://loinc.org",
"code" : "66746-9",
"display" : "Specimen Type"
},
{
"system" : "http://snomed.info/sct",
"code" : "123038009",
"display" : "Specimen"
}
],
"text" : "Specimen Source",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismBloodPB",
"display" : "Blood (PB)"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismBoneMarrowBM",
"display" : "Bone Marrow (BM)"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "ChimIG/specimen_source-designNote",
"text" : "Confirmed as this 2-value list (Blood (PB), Bone Marrow (BM)) from the\nHive/Histotrac order-entry UI's Chimerism panel - a different list from the\nBlood/Buccal/Other list [HLA Tests -\nTransplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) uses for the\nsame underlying `code` (LOINC `66746-9`), since the two order screens offer\ndifferent specimen-source options in Hive. Coded locally against the\n`NWGMSA` CodeSystem rather than the EU/UK/NW-compatible\n[Specimen Type](ValueSet-specimen-type.html) value set, to match what Hive\nactually offers for this exchange. Deliberately given its own\n`ChimIG/specimen_source` linkId rather than reusing the base [Genomic Test\nOrder](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type\nitem - the IG Publisher's Questionnaire derivation validator does not support a\n`derivedFrom`/`extends` item reusing a base item's linkId while also declaring\nmore than one `answerOption`. Ordered first (before Patient Test(s)) to match\n`NTE|1` in the live Histotrac order - the reverse of HLA Tests - Transplant, where\nPatient Test(s) comes first.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "ChimIG/specimen_source-reference",
"text" : "Post-transplant chimerism monitoring conventionally uses peripheral blood, with\nbone marrow used for deeper/marrow-level engraftment assessment - consistent with\nthis 2-value list. If a coded alternative to the local `NWGMSA` codes is wanted,\nthe [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate\nbinding (e.g. whole blood specimen for Blood (PB); bone marrow specimen for Bone\nMarrow (BM)). No dedicated NHS-published specimen-type binding specific to H&I\nchimerism testing was found.",
"type" : "display"
}
]
},
{
"linkId" : "ChimIG/patient_test",
"definition" : "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.orderDetail",
"text" : "Patient Test(s)",
"type" : "choice",
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismPeripheralBlood",
"display" : "Chimerism Peripheral Blood"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismCD3",
"display" : "Chimerism CD3"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismCD15",
"display" : "Chimerism CD15"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismCD19",
"display" : "Chimerism CD19"
}
},
{
"valueCoding" : {
"system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code" : "ChimerismLineageOther",
"display" : "Chimerism Lineage Other"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "ChimIG/patient_test-designNote",
"text" : "Which chimerism panel/lineage is being tested - the same Ask At Order Entry\npattern as `HistoIG/patient_test` on\n[HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html)\n(`repeats = true`, since the Hive UI presents them as checkboxes - more than one\nmay be selected per order). Confirmed as this fixed 5-value checklist from the\nHive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem, as\nno NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists. Ordered second\n(after Specimen Source) to match `NTE|2` in the live Histotrac order, whose\nNTE-3 value carries a `(PB)` suffix (\"Chimerism Peripheral Blood (PB)\") the Hive\ncheckbox label itself doesn't show - the same OBR-4-restatement behaviour as HLA\nTests - Transplant's Patient Test(s) item. Mapped to `ServiceRequest.orderDetail`\nrather than `ServiceRequest.code` - the same reasoning as that item:\n`ServiceRequest.code` is single-cardinality and already targeted by the base\n[Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item,\nwith no `enableWhen` to say which wins, while `orderDetail` is repeating and\nintended for exactly this kind of further order qualifier.",
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help"
}
]
}
}
],
"linkId" : "ChimIG/patient_test-reference",
"text" : "No MFT/NHS England code set was found for these five specific test names. LOINC\nhas short tandem repeat (STR)/chimerism-adjacent panels (e.g. `48018-6` Gene\nstudied, engraftment-monitoring local codes used elsewhere in genetics\nlaboratories) but no exact match for a CD3/CD15/CD19 lineage-specific chimerism\nchecklist was confirmed - a candidate future binding if a coded alternative to\nthe local `NWGMSA` codes is wanted. See also this IG's existing\n[Chimerism](CodeSystem-Chimerism.html) CodeSystem, which covers the *result*\npayload's OBX-3 sub-identifiers (STR/IM/RANGE/CV/EXT/PURE/POST/DTP/DID) rather\nthan these order-entry test-selection values.",
"type" : "display"
}
]
}
]
}
]
}